Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users

Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Korea

Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea

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Nutrition and Metabolism Unit, IDS Building, Southampton General Hospital, (University of Southampton) and Southampton National Institute for Health Research Biomedical Research Centre, Southampton SO17 1BJ, UK

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Department of Gastroenterology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA

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Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Korea

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Department of Preventive Medicine and Institute of Occupational and Environmental Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea

Authors to whom correspondence should be addressed.

^†

These authors are co-first authors.

J. Clin. Med. 2019, 8(10), 1571; https://doi.org/10.3390/jcm8101571

Received: 29 August 2019 / Revised: 23 September 2019 / Accepted: 27 September 2019 / Published: 1 October 2019

(This article belongs to the Special Issue Current and Emerging Uses of Statins in Clinical Therapeutics)

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Abstract

We aimed to test the association between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD), cancer, and all-cause mortality in non-statin users. A total of 347,971 subjects in Kangbuk Samsung Health Study (KSHS.57.4% men, mean follow up: 5.64 ± 3.27 years) were tested. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES, 182,943 subjects). All subjects treated with any lipid-lowering therapy and who died during the first 3 years of follow up were excluded. Five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL). A total of 2028 deaths occurred during follow-up in KSHS. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.95, 1.55–2.47), CVD mortality (HR 2.02, 1.11–3.64), and cancer mortality (HR 2.06, 1.46–2.90) compared to the reference group (LDL 120–139 mg/dL). In the validation cohort, 2338 deaths occurred during follow-up. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality (HR 1.81, 1.44–2.28) compared to the reference group. Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD, and all-cause mortality. These findings suggest that more attention is needed for subjects with no statin-induced decrease in LDL-C concentrations. View Full-Text

Keywords: low density lipoprotein cholesterol; mortality; cancer; cardiovascular disease

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MDPI and ACS Style

Sung, K.-C.; Huh, J.H.; Ryu, S.; Lee, J.-Y.; Scorletti, E.; Byrne, C.D.; Kim, J.Y.; Hyun, D.S.; Ko, S.-B. Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users. J. Clin. Med. 2019, 8, 1571. https://doi.org/10.3390/jcm8101571

AMA Style

Sung K-C, Huh JH, Ryu S, Lee J-Y, Scorletti E, Byrne CD, Kim JY, Hyun DS, Ko S-B. Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users. Journal of Clinical Medicine. 2019; 8(10):1571. https://doi.org/10.3390/jcm8101571

Chicago/Turabian Style

Sung, Ki-Chul, Ji Hye Huh, Seungho Ryu, Jong-Young Lee, Eleonora Scorletti, Christopher D Byrne, Jang Young Kim, Dae Sung Hyun, and Sang-Baek Ko. 2019. "Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users" Journal of Clinical Medicine 8, no. 10: 1571. https://doi.org/10.3390/jcm8101571

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Low Levels of Low-Density Lipoprotein Cholesterol and Mortality Outcomes in Non-Statin Users

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