Residual Cholesterol and Inflammation Risks Persist After Statin Use in CVD

Residual cholesterol and inflammation risk may increase among individuals with cardiovascular disease (CVC) even after undergoing lipid-lowering therapy, according to research published in Cardiovascular Diabetology. Statin compliance, low density lipid-cholesterol (LDL-C), SMART 2 risk score, blood pressure control, and blood glucose control are all variables affecting this risk, according to the report.

Researchers reviewed data from 3509 patients (mean age, 63.69 years; 86.78% men) with CVD from the Kailuan Study who began a statin regimen between January 2010 and December 2017. The team assessed LDL-C and hypersensitive C-reactive protein levels and stratified participants into 1 of 4 groups including individuals with no residual risk (n=613), patients with residual inflammatory risk (n=295), participants with residual cholesterol risk (n=1628), and individuals with combined residual cholesterol and inflammation risk (n=973).

A total of 377 all-cause deaths occurred during a 6.1-year follow-up period. After adjusting for related risk factors, individuals with residual inflammation risk (hazard ratio [HR], 1.63; 95% CI, 1.05-2.52), residual cholesterol risk (HR, 1.37; 95% CI, 0.98-1.980) and residual cholesterol and inflammation risk (HR, 1.75; 95% CI, 1.25-2.46) demonstrated a higher risk of all-cause mortality compared with participants with no residual risk.   

Study participants with simultaneous residual cholesterol and inflammation risk with high SMART 2 risk scores (≥20%) or who demonstrated noncompliance with statin use also showed an increased risk for all-cause mortality (HR, 1.67; 95% CI, 1.16-2.40 and HR, 1.69; 95% CI, 1.09-2.66, respectively).

Study limitations include an overrepresentation of men in the study sample, failure to collect statin dosage data, and failure to differentiate between CVD-related and non-CVD-related causes of death.

“[I]t is necessary for clinicians and health systems to eliminate the residual risk of cholesterol and inflammation in patients with CVD by closely following statin adherence, testing LDL-C levels at specific intervals, and regularly discussing ways to improve statin adherence, including adherence to medication and a healthy lifestyle,” according to the researchers.