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Association Between BMI and Cardiovascular Benefits After More Intensive LDL-C Lowering Strategy: A Systematic Review and Meta-Analysis

23 Pages Posted: 25 Aug 2021

See all articles by Guangpeng Zhou

Guangpeng Zhou

Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital - Department of Intensive care unit

Pinq Wang

Medical School of Southeast University - Department of Endocrinology

Sen Lu

Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital - Department of Intensive care unit

Chenchen Wang

ZhongDa Hospital of Southeast University - Department of Endocrinology

Zuoling Xie

ZhongDa Hospital of Southeast University - Department of Endocrinology

Wuyou Cao

ZhongDa Hospital of Southeast University - Department of Endocrinology

Jijing Shi

ZhongDa Hospital of Southeast University - Department of Endocrinology

Wenwen Zhu

ZhongDa Hospital of Southeast University - Department of Endocrinology

Rui Wang

Peking University First Hospital - Department of Radiology

Guangpeng Zhou

affiliation not provided to SSRN

Shaohua Wang

Southeast University - Department of Endocrinology

Pin Wang

Medical School of Southeast University - Department of Endocrinology

More...

Abstract

Objective: To assess the influencing factors, especially BMI level contributing to the cardiovascular benefits of more intensive LDL-C lowering strategy.

Methods: We systematically searched MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, ClinicalTrials and Embase for randomized controlled trials of statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, ATP Citrate Lyase inhibitors published before April, 2021.

Results: A total of 263787 participants from 33 trials were included. BMI level, baseline LDL-C level and type of lipid-lowering agents are the main factors affecting the cardiovascular benefits from more intensive LDL-C lowering strategies. Among them, the influence of BMI is more prominent. Each 1kg/m2 increase in BMI level reduced the benefit of cardiovascular mortality by 8% (RR 1.08, 95% CI 1.03-1.13), and this effect still exists when only statins are used as the LDL-C lowering strategy. The same trend was also found in myocardial infarction (RR 1.06, 95% CI 1.01-1.11) and revascularization events (RR 1.06, 95% CI 1.02-1.10) by 6%, respectively. Compared to 44% reduction of cardiovascular mortality when the BMI level was less than 25kg/m2 (RR 0.56, 95%CI 0.36-0.86), the reduction gradually vanished as the BMI increased, no benefit of cardiovascular mortality was found when the BMI was higher than 28kg/m2, this cut point is 29kg/m2 in myocardial infarction and 30kg/m2 in revascularization events.

Conclusions: With the increase of BMI level, some cardiovascular benefits of intensive LDL-C lowering strategy gradually vanished.

Funding Information: This work was partially supported by the National Natural Science Foundation of China (No. 81570732, Shaohua Wang and No. 81870568, Shaohua Wang).

Declaration of Interests: The authors declare that they have no competing interests.

Keywords: LDL-C lowering strategies, body mass index, cardiovascular mortality

Suggested Citation

Zhou, Guangpeng and Wang, Pinq and Lu, Sen and Wang, Chenchen and Xie, Zuoling and Cao, Wuyou and Shi, Jijing and Zhu, Wenwen and Wang, Rui and Zhou, Guangpeng and Wang, Shaohua and Wang, Pin, Association Between BMI and Cardiovascular Benefits After More Intensive LDL-C Lowering Strategy: A Systematic Review and Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=3911102 or http://dx.doi.org/10.2139/ssrn.3911102

Guangpeng Zhou

Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital - Department of Intensive care unit ( email )

United States

Pinq Wang (Contact Author)

Medical School of Southeast University - Department of Endocrinology ( email )

United States

Sen Lu

Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital - Department of Intensive care unit ( email )

United States

Chenchen Wang

ZhongDa Hospital of Southeast University - Department of Endocrinology ( email )

United States

Zuoling Xie

ZhongDa Hospital of Southeast University - Department of Endocrinology ( email )

United States

Wuyou Cao

ZhongDa Hospital of Southeast University - Department of Endocrinology ( email )

United States

Jijing Shi

ZhongDa Hospital of Southeast University - Department of Endocrinology ( email )

United States

Wenwen Zhu

ZhongDa Hospital of Southeast University - Department of Endocrinology ( email )

United States

Rui Wang

Peking University First Hospital - Department of Radiology ( email )

United States

Guangpeng Zhou

affiliation not provided to SSRN

Shaohua Wang

Southeast University - Department of Endocrinology ( email )

Nanjing
China

Pin Wang

Medical School of Southeast University - Department of Endocrinology ( email )

United States