The Study
2013 Cholesterol Guidelines Revisited: Percent LDL Cholesterol Reduction or Attained LDL Cholesterol Level or Both for Prognosis?
This study looked at people who were already taking statins and noticed that those whose bad cholesterol dropped by a lot (50% or more) tended to have fewer heart problems later. But it didn’t make anyone take more medicine — it just watched what happened, so we can’t say the drop in cholesterol caused the better outcome.
Analysis score
Maximum 72 for a cohort study.
Where the score came from
Doctors give statins to people who already had heart problems to lower their bad cholesterol. This study looked at whether it matters more how much the cholesterol drops from its original level, or just how low it ends up.
Where does this study sit?
Reviews of RCTs (Meta-analyses)
Max 100Randomized Trials
Max 90Reviews of Cohort Studies
Max 85Cohort Studies
Max 72Reviews of Case-Control Studies
Max 63Case-Control Studies
Max 58Cross-Sectional & Case Series
Max 50Expert Opinion
Max 567 / 100
Quality score
Groups of people are followed over time to see who develops an outcome. Strong for identifying risk factors and associations, but cannot prove causation as firmly as RCTs.
Key takeaways
Summary
Based on the study abstract and findings.
- 1Yes — even if your cholesterol is already 'low enough' by guidelines, if it didn't drop much from where it started, you're still at higher risk.
- 2The change matters more than the final number.
- 3People whose cholesterol dropped by 50% or more had 51% fewer heart attacks and strokes than those whose cholesterol dropped less — even if both groups ended up with cholesterol below 70 mg/dL.
- 4Every 1% drop in cholesterol meant a 1% lower risk of heart events.
Score breakdown, methodology, conflicts of interest, evidence analysis & raw study data
Publication
Journal
The American journal of medicine
Year
2016
Authors
S. Bangalore, R. Fayyad, J. Kastelein, R. Laskey, P. Amarenco, D. Demicco, D. Waters
Related Content
Claims (6)
In patients with heart disease taking statins, those who reduce their LDL cholesterol by 50% or more have a 51% lower risk of heart attacks or strokes than those who reduce it by less than 50%, even if both groups end up with the same low LDL level.
In patients with atherosclerotic cardiovascular disease taking statins, those whose LDL cholesterol decreases by less than 50% have a 107% higher risk of stroke than those whose LDL cholesterol decreases by 50% or more, even when both groups end up with LDL cholesterol below 70 mg/dL.
For patients with atherosclerotic cardiovascular disease taking statins, the amount of statin prescribed does not determine the risk of major heart events; instead, how much the LDL cholesterol level drops and the final cholesterol level achieved are what matter.
For patients with atherosclerotic cardiovascular disease taking statins, the final level of LDL cholesterol does not improve prediction of future heart events beyond what is already known from how much LDL cholesterol decreased from the starting level and the dose of statin taken.
For patients with atherosclerotic cardiovascular disease taking statins, every 1% decrease in LDL cholesterol from their starting level corresponds to a 1% decrease in the risk of major cardiovascular events.
Statins lower the amount of LDL cholesterol in the blood by blocking HMG-CoA reductase, an enzyme that produces cholesterol in the liver.
Not medical advice. For informational purposes only. Always consult a qualified healthcare professional before making health decisions.