Age and the Residual Risk of Cardiovascular Disease following Low Density Lipoprotein-Cholesterol Exposure

Carola König*, Amar Mann, Rob McFarlane, John Marriott, Malcolm Price, Sudarshan Ramachandran*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

We believe that there is sufficient evidence from basic science, longitudinal cohort studies and randomised controlled trials which validates the low-density lipoprotein cholesterol (LDL-C) or lipid hypothesis. It is important that we can communicate details of the cardiovascular disease (CVD) risk reduction that the average patient could expect depending on the scale of LDL-C decrease following lipid lowering therapy. It is also essential that residual risk (ResR) of CVD be highlighted. To achieve this aim by using existing trial evidence, we developed mathematical models initially for relative risk reduction (RRR) and absolute risk (AR) reduction and then showed that despite optimising LDL-C levels, a considerable degree of ResR remains that is dependent on AR. Age is significantly associated with AR (odds ratio: 1.02, 95% confidence intervals: 1.01–1.04) as was previously demonstrated by analysing the Whickham study cohort using a logistic regression model (age remaining significant even when all the other significant risk factors such as sex, smoking, systolic blood pressure, diabetes and family history were included in the regression model). A discussion of a paper by Ference et al. provided detailed evidence of the relationship between age and AR, based on lifetime LDL-C exposure. Finally, we discussed non-traditional CVD risk factors that may contribute to ResR based on randomised controlled trials investigating drugs improving inflammation, thrombosis, metabolic and endothelial status.
Original languageEnglish
Article number3208
Number of pages13
JournalBiomedicines
Volume11
Issue number12
DOIs
Publication statusPublished - 2 Dec 2023

Bibliographical note

This article belongs to the Special Issue Atherosclerotic Cardiovascular Disease (ASCVD), Dyslipidemia, and CV Residual Risk: From Mechanisms to Therapeutic Approaches 2.0

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