A recent meta-analysis of 11 trials with 101,357 participants explored the impact of intensive lipid-lowering therapy over 5 years. While the relative risk (RR) numbers look impressive, the absolute risk (AR) tells a more modest story. Here's the breakdown: 👇
Primary Outcomes
✅ MACE (Major Cardiovascular Events):
Relative Risk Reduction (RRR): 13%
Absolute Risk Reduction (ARR): Only 2.4%
Events delayed: 23.5 days
✅ Heart Attack (MI):
RRR: 14%
ARR: Only 1.5%
Events delayed: 14.6 days
✅ Stroke:
RRR: 17%
ARR: Only 0.6%
Events delayed: 5.3 days
❌ All-Cause Mortality:
RRR: Minimal
ARR: No significant change.
Why This Matters
🚨 Relative Risk (RR) numbers can be luring, suggesting large benefits without context.
✅ Absolute Risk (AR) reveals the true impact: For every 100 patients treated intensively for 5 years, only 2 additional patients avoid a cardiovascular event.
This modest benefit raises questions about the justification of intensive LDL reduction for many patients, especially given the costs, side effects, and treatment burdens.
The Takeaway
Intensive therapy may still benefit high-risk individuals, but for others, the modest absolute benefits should be carefully weighed. Patients and healthcare providers must consider this context for informed, shared decision-making.
van Bruggen, F.H., et al., Time Gained to Cardiovascular Disease by Intensive Lipid-Lowering Therapy: Results of Individual Placebo-Controlled Trials and Pooled Effects. American Journal of Cardiovascular Drugs, 2024. 24(6): p. 743-752.
#CholesterolReduction #CardiovascularRisk #LipidLoweringTherapy #EvidenceBasedMedicine #LDLCholesterol
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