A report in the journal Circulation pointed out that tools for mortality prediction in patients with the severe hypercholesterolemia phenotype—defined as LDL-C ≥190 mg/dL—are limited and restricted to specific racial and ethnic cohorts.
The Montefiore Healthcare Network/Albert Einstein College of Medicine–led study sought to evaluate the predictors of long-term mortality in a large, racially and ethnically diverse U.S. patient cohort with LDL-C of 190 mg/dL or greater.
To do that, the study team conducted a retrospective analysis of all patients with LDL-C at those levels who sought care at Montefiore from 2010 through 2020. The primary end point was defined as all-cause mortality.
The participants were 18,740 patients who were 37% non-Hispanic black, 30% Hispanic, 12% non-Hispanic white, and 2% non-Hispanic Asian. Their mean age was 53.9 years, and median follow-up was 5.2 years.
The results indicated that both HDL-C and BMI extremes were associated with higher mortality in univariate analyses. In adjusted models, higher LDL-C and triglyceride levels were associated with an increased 9-year mortality risk (adjusted hazard ratio [HR], 1.08; 95% CI, 1.05-1.11] and 1.04 [95% CI, 1.02-1.06] per 20-mg/dL increase, respectively).
Clinical factors associated with higher mortality included:
• Male sex (adjusted HR, 1.31; 95% CI, 1.08-1.58)
• Older age (adjusted HR, 1.19 per 5-year increase; 95% CI, 1.15-1.23)
• Hypertension (adjusted HR, 2.01; 95% CI, 1.57-2.57)
• Chronic kidney disease (adjusted HR, 1.68; 95% CI, 1.36-2.09)
• Diabetes (adjusted HR, 1.79; 95% CI, 1.50-2.15)
• Heart failure (adjusted HR, 1.51; 95% CI, 1.16-1.95)
• Myocardial infarction (adjusted HR, 1.41; 95% CI, 1.05-1.90)
• BMI <20 kg/m2 (adjusted HR, 3.36; 95% CI, 2.29-4.93).
“A significant survival benefit was conferred by lipid-lowering therapy (adjusted HR, 0.57 [95% CI, 0.42-0.77]),” the researchers emphasized. “In the primary prevention group, high-density lipoprotein cholesterol <40 mg/dL was independently associated with higher mortality (adjusted HR, 1.49 [95% CI, 1.06-2.09]). Temporal trend analyses showed a reduction in statin use over time (P < 0.001). In the most recent time period (2019-2020), 56% of patients on primary prevention and 85% of those on secondary prevention were on statin therapy.”
The researchers added, “Our results support efforts geared toward early recognition and consistent treatment for patients with severe hypercholesterolemia.”
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