Cholesterol Levels and Cardiovascular Outcomes Following Statin Initiation for Primary Prevention: A Cohort Study (JACC: Advances July 2025)-Article: Cholesterol Levels and Cardiovascular Outcomes Following Statin Initiation for Primary Prevention: A Cohort Study

Article: Cholesterol Levels and Cardiovascular Outcomes Following Statin Initiation for Primary Prevention: A Cohort Study

Back to course

Pdf Summary

This study analyzed the impact of LDL-C and non-HDL-C cholesterol levels on cardiovascular outcomes in 125,013 individuals aged 66 and older in Ontario, Canada, after starting statin therapy for primary prevention from 2012 to 2019. The study used a cohort design to investigate whether post-statin initiation lipid levels compute significant cardiovascular risks, focusing particularly on non-HDL-C. Participants were categorized based on LDL-C and non-HDL-C thresholds in line with the 2021 Canadian Cardiovascular Society dyslipidemia guidelines, with stratification by the presence of diabetes or chronic kidney disease (CKD).<br /><br />Key findings indicate that individuals above both LDL-C and non-HDL-C thresholds after starting statins had higher rates of adverse cardiovascular events, particularly among those with diabetes or CKD. Specifically, having LDL-C below but non-HDL-C above the guideline thresholds still presented a heightened risk for the diabetic/CKD group. The study found that the cholesterol-related cardiovascular risks were not significantly pronounced in participants without diabetes or CKD. Statins generally lowered LDL-C and non-HDL-C levels, but the study pointed out a "residual risk" where cholesterol levels remain above target thresholds correlating with an increased risk of cardiovascular events.<br /><br />This research underlines the potential importance of monitoring both LDL-C and non-HDL-C levels in statin-treated individuals, especially those with diabetes or CKD, and suggests that non-HDL-C could serve as a crucial risk marker for more precise cardiovascular risk management. The researchers advocate that clearer guidelines incorporating non-HDL-C as a treatment target might be more beneficial, particularly for individuals at an elevated baseline risk.

Keywords

LDL-C

non-HDL-C

cardiovascular outcomes

statin therapy

primary prevention

diabetes

chronic kidney disease

residual risk

Canadian Cardiovascular Society

lipid levels