Beyond Statins: Reducing Cardiovascular Risk With Other Treatments

HealthDay News – Treatments other than statins also can effectively reduce cardiovascular risk, according to a review and meta-analysis published in the Journal of the American Medical Association.

Marc Sabatine, MD, MPH, a cardiologist at Brigham and Women’s Hospital in Boston, and colleagues analyzed the results of 49 clinical trials. These included 25 clinical trials for statins, as well as trials for heart-healthy diet, ezetimibe, bile acid sequestrants, and ileal bypass surgery. The evidence review also included 2 trials with PCSK9 inhibitors.

Non-statin therapies reduced cardiovascular risk by 25% for each 1 mmol/L decrease in low-density lipoprotein cholesterol (LDL-C) levels. That was similar to the 23% reduction per 1 mmol/L decrease seen with statins like atorvastatin and simvastatin, the researchers said. Ezetimibe reduced cholesterol by about 20%, statins by 30% to 50% depending on dose, and PCSK9 inhibitors by as much as 60%, according to Dr Sabatine. But the different trials showed that each unit of LDL-C removed from the bloodstream protects cardiovascular health, regardless of how.

“There is a linear relationship between what your LDL-C level is and what your risk is of cardiovascular events,” Dr Sabatine told HealthDay. “The relationship suggests that lower is better.” What’s more, the benefits of these therapies stack up if more than one proves effective at lowering a person’s cholesterol levels, he added. “The focus really should be not on a particular drug, but on reducing LDL-C. These data show there are multiple interventions that can do that.”

Disclosures: Dr Sabatine reported receiving financial support from Abbott Laboratories, Accumetrics, Amgen, AstraZeneca, Bristol-Myers Squibb, Critical Diagnostics, Daiichi Sankyo, Eisai, Genzyme, Gilead, GlaxoSmithKline, Intarcia, Janssen Research and Development, MedImmune, Merck, Novartis, Poxel, Roche Diagnostics, Sanofi-Aventis, and Takeda. Dr Sabatine also serves as a consultant for Alnylam, Amgen, AstraZeneca, Bristol-Myers Squibb, Cubist, CVS Caremark, Intarcia, Inois, The Medicines Company, Merck, MyoKardia, Pfizer, Quest Diagnostics, Sanofi-Aventis, and Zeus Scientific. 

Dr Ference reported receiving research grants from Merck, Amgen, Esperion Therapeutics, and Inois Therapeutics as well as consulting fees, serving on advisory boards, and honoraria from Merck, Amgen, Esperion Therapeutics, Ionis Therapeutics, Celera, and Quest Diagnostics.

Dr Wiviott reported receiving research grants from AstraZeneca, Bristol-Myers Squibb, Eisai, Arena, Merck, Eli Lilly/Daiichi Sankyo, and Sanofi-Aventis as well as consulting fees from AstraZeneca, Bristol-Myers Squibb, Arena, Aegerion, Anglemed, Janssen, Xoma, ICON Clinical, Boston Clinical Research Institute, Eli Lilly/Daiichi Sankyo, and Boehringer Ingelheim, and that spouse is an employee of Merck Research Laboratory. 

Dr Giugliano reported receiving institutional research support from Amgen, Daiichi Sankyo, and Merck as well as honoraria from Amgen, Daiichi Sankyo, and Merck, and consulting fees from Amarin, Amgen, Boehringer Ingelheim, Bristol-Meyers Squibb, CVS Caremark, Daiichi Sankyo, GlaxoSmithKline, Lexicon, Merck, Portola, Pfizer, Regeneron, Sanofi-Aventis, St Jude, and Stealth Peptides. 

Dr Braunwald reported receiving institutional grant support from AstraZeneca, Novartis, Duke University, Merck, Daiichi Sankyo, and GlaxoSmithKline as well as serving as a consultant for The Medicines Company, Sanofi-Aventis, and Theravance and personal fees for lectures from Daiichi Sankyo, Menarini International, Bayer, and Medscape.


Silverman MG, Ference BA, Im K, et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions. A systematic review and meta-analysis. JAMA. 2016;316(12):1289-1297. doi:10.1001/jama.2016.13985.