Findings from recent clinical trials of LDL cholesterol lowering suggest continued benefits at lower concentrations than those previously considered acceptable. In The Lancet Diabetes & Endocrinology, Nelson Wang and colleagues emphasise this concept in their large meta-analysis that incorporates results of 52 randomised controlled trials of cholesterol-lowering drugs with a primary composite cardiovascular endpoint. Across three mechanistically distinct drug classes—statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors—there was a direct linear association between pharmacological LDL cholesterol lowering and relative risk reduction in cardiovascular events. A 1 mmol/L reduction in LDL cholesterol corresponded to a relative risk reduction of 19%, irrespective of baseline LDL cholesterol concentration or drug class used. Although the analysis used average LDL cholesterol concentrations in the treatment versus control groups, rather than individual participant level data, it still provides compelling evidence for the cardiovascular benefit of LDL cholesterol reduction, with no apparent lower threshold for additional benefit.

中文翻译：

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LDL胆固醇：更低，更快，更年轻？

从最近降低LDL胆固醇的临床试验中发现，与以前认为可接受的浓度相比，在较低的浓度下仍具有持续的益处。在《柳叶刀》糖尿病与内分泌学中，Nelson Wang及其同事在大型荟萃分析中强调了这一概念，该分析纳入了52项具有主要复合心血管终点的降胆固醇药物随机对照试验的结果。在三种机理上截然不同的药物类别中，他汀类药物，依泽替米贝和前蛋白转化酶枯草杆菌蛋白酶/ kexin 9型（PCSK9）抑制剂在药理学上降低LDL胆固醇与降低心血管事件的相对风险之间存在直接的线性联系。LDL胆固醇降低1 mmol / L相当于相对危险度降低19％，而与基线LDL胆固醇浓度或所用药物类别无关。尽管该分析使用的是治疗组和对照组的平均LDL胆固醇浓度，而不是单个参与者水平的数据，