Endocrine Abstracts

Introduction: Cholesterol management is essential to prevent coronary artery disease (CAD) and related complications. Lifestyle changes are first treatment, followed by statin therapy. Multiple studies have shown statins to effectively reduce the risk of cardiovascular complications. LDL cholesterol is the main measure to assess impact of statin therapy. However, CAD risk also depends on other often neglected risk factors. We present preliminary data of the evaluation of the simultaneous effect of statins on LDL cholesterol and CAD risk.

Methods: Retrospective cohort evaluation of Olmsted County residents (Minnesota, USA) seen at Mayo Clinic. Clinical data were collected searching electronic medical records. The cohort was divided based on statin treatment or not during the study period, and if they developed CAD or not 1 year after the index date. The index date (time=0) was the date of the first statin prescription, with follow-up of quarterly LDL levels and CAD risk scores (Framingham) between -10 and +10 years. An AI model to predict CAD and tailored to our population was used to validate the Framingham Risk score with similar results.

Results: Contrary to expectations, in the general sample the prediction model showed that LDL was a negative predictor (-0.0052) and statin a positive predictor (0.4670) of CAD. Subjects who developed CAD vs. those without CAD had lower LDL in the group without statins (mean 110.3 vs. 115.3 mg/dl) and in the group with statins (126.7 vs 135.2). Framingham risk score showed expected results, being higher in subjects who developed CAD vs. those without CAD, without statins (.079 vs .050) and with statins (.084 vs .067). Quarterly follow-up of those that received statin therapy, before and after the first statin prescription, showed a significant LDL reduction (approximately 30mg/dl) after statin initiation, being always higher in the group without CAD. However, the CAD risk showed no significant changes in either group at the time of statins initiation.

Conclusion: Our results support current practice of initiating statins based on calculated overall cardiovascular risk rather than LDL value alone. Despite a significant drop in LDL levels with statin therapy, the cardiovascular risk showed negligible changes, remaining higher in subjects who developed CAD. It is difficult to have a position on the statin mechanism impacting CAD based on the nature of our study. However, it seems evident that LDL reduction is insufficient, and better management of additional cardiovascular risk factors is critical and needed to prevent CAD complications.