Patients With Highest LDL Levels Benefit Most From Lipid-Lowering Drugs Interview with:

Dr. Jennifer Robinson, MD MPH professor of epidemiology, University of Iowa College of Public Health. CREDIT Tom Langdon

Dr. Robinson

Dr. Jennifer Robinson, MD MPH
Professor, Departments of Epidemiology & Medicine
Director, Prevention Intervention Center
Department of Epidemiology
University of Iowa What is the background for this study?

Response: Compared to previous placebo-controlled statin trials, the FOURIER trial where all patients were on high or moderate intensity statin, had no reduction in cardiovascular or total mortality and the reduction in cardiovascular events was less than expected.  However, other PCSK9 inhibitor trials performed in populations with higher baseline low density lipoprotein cholesterol (LDL-C) had cardiovascular risk reductions similar to that in the statin trails. What are the main findings?

Response: In meta-analyses of LDL-C lowering drug trials, we found that total and cardiovascular mortality were reduced only when the mean baseline LDL-C in the trial was >100 mg/dl.  We also found the higher the baseline LDL-C the greater the reduction in the risk of total and cardiovascular mortality.  For example, for each 40 mg/dl higher baseline LDL-C above , cardiovascular death was reduced by another 14%.

We also found the myocardial infarction, revascularizations, and major cardiovascular events were reduced when LDL-C was <100 mg/dl, but risk was reduced more when in trials with higher baseline LDL-C levels.  Stroke risk was reduced similarly across the range of baseline LDL-C levels.

Notably, the results of our meta-analyses predicted the recent results of the ODYSSEY OUTCOMES trial, where total mortality and MACE risk with the PCSK9 inhibitor alirocumab only appeared to be reduce when baseline LDL-C was >100 mg/dl. What should readers take away from your report?

Response: LDL-C lowering drugs reduce cardiovascular risk across the spectrum of cardiovascular risk.  However, LDL-C lowering drugs will produce even greater benefits when used in patients with higher LDL-C levels.

Very high risk patients with cardiovascular disease and other high risk characteristics (for example, polyvascular disease, familial hypercholesterolemia, diabetes, or other poorly controlled risk factors) who are treated with maximally tolerated statin therapy may still benefit from adding a nonstatin LDL-C lowering drug to reduce the risk of nonfatal coronary events and stroke. What recommendations do you have for future research as a result of this work? 

Response: We need to find all of our patients with genetic and familial hypercholesterolemia and treat them with statins and other LDL-C lowering drugs as needed to reduce their risk of death and nonfatal cardiovascular events.

We also need to find ways to encourage better adherence to statins, which have proven mortality benefits, are inexpensive and safe. 

Disclosures: Research grants to institution from and scientific consultant for manufacturers of statins, ezetimibe, and PCSK9 inhibitors.


Navarese EP, Robinson JG, Kowalewski M, et al. Association Between Baseline LDL-C Level and Total and Cardiovascular Mortality After LDL-C LoweringA Systematic Review and Meta-analysis. JAMA.2018;319(15):1566–1579. doi:10.1001/jama.2018.2525 

[wysija_form id=”3″]



The information on is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.


1 Comment
  • Boris Larionov
    Posted at 04:02h, 19 April

    The administrator · on March 15, 2017 at 17:29 · Казань
    Boris Larionov MirVracha: General Issues Boris Larionov 274General Hygiene List of diseases caused by overeating of table salt! Due to overeating of sodium salt, hypertension and its complications arise – strokes, heart attacks, heart, kidney failure, senile dementia. Because of the overeating of the chloride salt, gastritis with increased acidity, irritable bowel syndrome, heartburn, esophagitis, GERD, duodenitis, enteritis, colitis, peptic ulcer, esophagus, duodenum, small and large intestine, gastrointestinal cancer from the oral cavity to the rectum , angiosarcoma of the rectum (the case with the designer of rockets by Korolev), lung cancer, breast cancer, gall bladder cancer, skin melanoma. For details, see FB in the group How to Prevent Caries, Hypertension, Ulcer, Cancer, Angiosarcoma For details, see FB in the group How to Prevent Caries, Hypertension, Ulcer, Cancer, Angiosarcoma Literature Larionov BV Biogeochemical sodium theory of etiology, prevention and geographical spread of hypertonic and hypotonic diseases. Kazan, 1984, p.1-88. The deposited manuscript of the monograph is presented by the Academic Council of the Kazan Medical Institute. Dep. VNIIMI USSR Ministry of Health No. 8582-84. The abstract was published in the Medical Abstract Journal, Section I, “Internal Diseases”, 1984, No. 12, abstract No. 4230.
    Larionov BV The effect of excess chlorides on the occurrence of hyperacid conditions – esophagitis, gastritis, duodenitis, enteritis, ulcerative colitis, peptic ulcer of the esophagus, stomach and duodenum, esophageal cancer, stomach cancer and intestinal cancer (New biogeochemical single-causal paradigm). Collection of proceedings and materials of the Fifth International Symposium 26 – 28 May 2008 Volume 3. (Additional). Kazan. 2008, p. 52-61.
    Larionov BV How can I extend my life? How to reduce mortality in Russia? Excess consumption of salt – the cause of death number 1, the excess consumption of animal fat – the cause of death number 2. The new paradigm is the biogeochemical theory of etiology, prevention and geographical spread of hypertensive and ulcer diseases, their pre-illness and complications, as well as the prevention of atherosclerosis. Etiological and medical geographic sketches of preventive or hygienic cardiology, gastroenterology, pediatrics, gerontology and dietology. 2014. 612 pages of 97 tables. West Germany, Lap Lambert.
    PREVENTION OF NON-INFECTIOUS DISEASES IS THE IMPORTANT DIRECTION OF FUNDAMENTAL MEDICINE Larionov BV Kazan State Medical Institute, Kazan, Russia Published: II INTERREGIONAL CONFERENCE OF CARDIOLOGISTS AND THERAPIES December 5-6, 2016, Ulyanovsk MATERIALS OF THE FORUM Special issue of the journal Cardiovascular Therapy and Prevention, 2016; 15 (December)
    Larionov BV Overeating table salt – the cause of death number 1. Theoretical and practical problems of the development of modern science. Makhachkala, 11/30/2014. Pp. 158-159.
    Larionov BV Influence of excessive consumption of table salt on the mortality of the population. Actual problems of modern science in the 21st century. Makhachkala. 2016. 220-231.
    Larionov BV The sodium content in the urine at different arterial pressures. Trends in the development of science and education. Collection of scientific papers. International Scientific and Practical Conference on July 21, 2016. Part I. Smolensk. 2016, p. 17-19.