Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive patients: A post-hoc SPRINT data analysis

Lee Nguyen (1, 2, 3) , Niki Procopi (1) , Joe-Elie Salem (2, 3) , Pierre Squara (1) , Christian Funck-Brentano (2, 3)

1 Hôpital Ambroise Paré [AP-HP]
2 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
3 CHU Pitié-Salpêtrière [AP-HP]

BACKGROUND: Patients at increased cardiovascular (CV) risk, noticeably hypertensive patients, have multiple CV risk factors which may be treatment targets. LDL-cholesterol is one of such targets. Using the SPRINT cohort, studying the cardiovascular outcomes of hypertensive patients at increased CV risk, this post-hoc study aimed to assess the association of LDL-C with CV outcomes. METHODS: Clinical outcomes were those defined in SPRINT: a composite of various CV outcomes, all-cause mortality, and CV mortality. Association between LDL-C and the primary outcome was analyzed using survival regression adjusted on confounding factors (age, sex, body-mass index, active smoking status, eGFR-estimated kidney function, history of CV disease, Framingham risk score, SPRINT treatment arm (intensive or control), baseline high-density-lipoprotein-bound cholesterol, and co-treatments by aspirin and statins). RESULTS: LDL-C was not associated with the primary outcome in the overall cohort (n = 9631). Among patients in secondary prevention (i.e. with a previous history of CV disease) (n = 1562), LDL-C was marginally associated with the incidence of the primary outcome (adjusted hazard-ratio 1.005 (95% CI = 1.002-1.009), p = 0.005 (per 1 mg/dl increase)) however, discrimination was poor with a ROC AUC of 0.54, p = 0.087. There was no association between LDL-C and the primary outcome in other subgroup analyses (those under statin or not, and those in primary prevention). CONCLUSION: This post-hoc analysis of SPRINT indicates that LDL-C levels do not influence cardiovascular events over a period of 3 years in a large cohort of hypertensive patients at increased risk of cardiovascular events but without previous history of clinical cardiovascular disease other than stroke.

Mots clés: Cardiovascular diseases/prevention & control; Cholesterol; Dyslipidemias; Hypertension/drug therapy; Hypolipidemic agents; LDL; Treatment outcome

Domaines: Cardiologie et système cardiovasculaire; Santé publique et épidémiologie

Lee Nguyen, Niki Procopi, Joe-Elie Salem, Pierre Squara, Christian Funck-Brentano. Relation between baseline LDL-cholesterol and cardiovascular outcomes in high cardiovascular risk hypertensive patients: A post-hoc SPRINT data analysis. International Journal of Cardiology, 2019, 286, pp.159-161. ⟨10.1016/j.ijcard.2019.01.048⟩. ⟨hal-02136104⟩