Baseline, delta, and achieved low‐density lipoprotein cholesterol levels and cardiovascular risk in patients on statin therapy: A post‐hoc resampling mediation analysis of treating new targets [TNT] trial

Clinical guidelines for monitoring low‐density lipoprotein cholesterol (LDL‐C) after statin therapy do not clearly define the clinical roles of baseline LDL‐C, ΔLDL‐C, and achieved LDL‐C according to statin intensity. We performed post‐hoc analysis of the Treating to New Target (TNT) study to evalua...

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Bibliographic Details
Published in:Clinical and experimental pharmacology & physiology 2020-10, Vol.47 (10), p.1649-1658
Main Authors: Hyun, Myung Han, Jang, Jae Won, Lee, Eunmi, An, Hyonggin, Seog Seo, Hong
Format: Article
Language:English
Subjects:
Aged
Cardiovascular diseases
Cardiovascular Diseases - blood
Cardiovascular Diseases - prevention & control
cardiovascular outcome
Cholesterol
Cholesterol, LDL - blood
Collinearity
Data analysis
Density
Female
Health risks
Heart Disease Risk Factors
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Low density lipoprotein
low‐density lipoprotein cholesterol
Male
Mediation
Mediation Analysis
Middle Aged
Parameters
Resampling
resampling mediation analysis
statin therapy
Statins
Therapy
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Summary:Clinical guidelines for monitoring low‐density lipoprotein cholesterol (LDL‐C) after statin therapy do not clearly define the clinical roles of baseline LDL‐C, ΔLDL‐C, and achieved LDL‐C according to statin intensity. We performed post‐hoc analysis of the Treating to New Target (TNT) study to evaluate individual LDL‐C parameters after statin therapy. Primary outcome was the risk for total major adverse cardiovascular events (MACE). We use resampling multilevel mediation analysis to analyze complex relationships among LDL‐C parameters based on similar statin intensities. Tertiles for resample A (matched baseline LDL‐C; distinct achieved LDL), resample B (matched ΔLDL‐C; distinct baseline LDL‐C), and resample C (matched achieved LDL‐C; distinct ΔLDL‐C) were analyzed using Cox proportional hazard ratios. In original data analysis, the incidence of MACE was reduced in those with lower achieved LDL‐C in total, low, and high intensity statin users (hazard ratios [HRs] = 0.990, 0.992, 0.992; respectively; all P‐values 
ISSN:0305-1870
1440-1681
DOI:10.1111/1440-1681.13367