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Open AccessArticle

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

1
Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
2
Division of Endocrinology and Metabolism, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
3
Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
4
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
7
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)
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 low density lipoprotein cholesterol; mortality; cancer; cardiovascular disease
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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.

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