High density lipoprotein cholesterol (HDL-C) has many protective effects in the human body. HDL-C is thought to slow the build up of plaque in the arteries within the heart. Low density lipoprotein cholesterol (LDL-C) has the opposite effect in that it contributes to plaque formation within the heart. Statin medications are commonly used for the prevention of cardiovascular (CV) disease. While these medications usually cause LDL-C levels to decrease, they have also been shown to decrease HDL-C in some patients, and this decrease in HDL-C has been related to CV events such as heart attack and stroke in previous studies. This study, in people using statins for 6 months or less, seeks to further understand the relationship between decreases in HDL-C and CV events. People who have a decrease in HDL-C after starting a statin will be compared to those whose HDL-C does not change and the number of CV events in each group will be compared. This study will provide important evidence concerning the effect of statins on different types of cholesterol and the relationship between these effects and CV disease.
High density lipoprotein cholesterol (HDL-C) has many biologically protective effects. HDL-C is thought to remove excess cholesterol from cells, transport it to the liver for excretion, to maintain cholesterol homeostasis in the body, and may also slow atherosclerosis through antioxidant and anti-inflammatory activity. Statin medications are commonly used for primary and secondary prevention of cardiovascular (CV) events. While these medications decrease low density lipoprotein cholesterol, they have also been shown to decrease HDL-C in some patients, and this decrease in HDL-C has been associated with increased risk of CV events. This retrospective cohort study in statin initiators using statins for 6 months or less will generate additional evidence surrounding the association between decreases in HDL-C and risk of subsequent CV events. Subjects with a decrease in HDL-C post statin initiation will be compared to those with constant HDL-C for the occurrence of subsequent CV events. Propensity score weighting will be used to adjust for confounding and log binomial and Cox proportional hazards regression will be used to estimate risk differences and hazard ratios, respectively.
Primary outcome: major adverse cardiovascular events (myocardial infarction, revascularization, ischemic stroke, cardiovascular related death)
Julia DiBello - Chief Investigator - Merck & Co., Inc.
Julia DiBello - Corresponding Applicant - Merck & Co., Inc.
J. Bradley Layton - Collaborator - RTI Health Solutions ( USA )
Til Stürmer - Collaborator - University of North Carolina at Chapel Hill
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation