Reduction in LDL – Cardiology MCQ – Answer

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Reduction in LDL – Cardiology MCQ – Answer

1 mmol/l (38.7 mg/dl) reduction in LDL cholesterol can lower atherosclerotic cardiovascular events by — in a few years – Correct answer: a) 20%

This has been derived from over 25 cardiovascular outcome trials with statins [1]. Cholesterol Treatment Trialists’ (CTT) Collaboration conducts periodic meta analysis of trials with 1000 or more participants and follow up of 2 years or more. They used individual participant data and the trials were mostly on statins. Data on 170,000 participants in 26 randomised trials was published in the Lancet [2]. Across 26 trials, 10% reduction in all cause mortality was noted per 1 mmol/l reduction in LDL cholesterol (p<0·0001).

Major cardiovascular events were reduced by a fifth for 1 mmol/l lowering of LDL cholesterol. It was further suggested that 2-3 mmol/l reduction in LDL could bring about a reduction of events by 40-50%.

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  1. Preiss D, Tobert JA, Hovingh GK, Reith C.  Lipid-Modifying Agents, From Statins to PCSK9 Inhibitors. JACC Focus Seminar. J Am Coll Cardiol. 2020;75(16):1945-55.
  2. Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, Bhala N, Peto R, Barnes EH, Keech A, Simes J, Collins R. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010 Nov 13;376(9753):1670-81.