Cumulative benefit of cholesterol and blood pressure-lowering on cardiovascular risk

A new study suggests that controlling both cholesterol and blood pressure can dramatically reduce a person’s lifetime risk of cardiovascular disease – a major type 2 diabetes complication.
According to the new findings, reported at this year’s European Society of Cardiology (ESC) Congress, even modest lowering of LDL cholesterol (LDL-C) and systolic blood pressure (SBP) represents a risk reduction of as much as 90 per cent.
The study’s lead investigator, Dr Brian Ference from Wayne State University School of Medicine in Detroit, and his colleagues found that the combination of achieving a 1 mmol/L lower LDL-C and 10 mm Hg lower SBP over a lifetime has the potential to significantly reduce cardiovascular risk.
The results demonstrate for the first time that LDL-C and SBP are risk factors that have independent, multiplicative, and cumulative effects on the risk of cardiovascular disease. And results indicate that this also hold true for people with apparently normal cholesterol and blood pressure levels.
For Dr Ference, prevention programmes should be recalibrated toward a common goal of keeping LDL-C and SBP low for as long as possible, as an observational research has shown fewer than five per cent of individuals are able to maintain such levels.
In order to evaluate the causal effect of long-term exposure to lower LDL as well as lower SBP, researchers used genetic and cardiovascular risk factor data from 102,773 individuals who had participated in 14 prospective studies looking at genetic variations known to be associated with LDL or SBP.
The genetic scores were used to divide people into four groups: a reference group; one below median LDL-C genetic score (resulting in lower LDL-C); one below median SBP genetic score (resulting in lower SBP); and a group with both LDL and SBP below the median (resulting in both lower LDL and lower SBP).
The researchers then assessed the cardiovascular risk associated with the genetic scores on the basis of the first occurrence of major vascular events such as coronary death, non-fatal myocardial infarctio, non-fatal stroke, or coronary revascularisation.
Over 32 years of follow-up, they found that a total of 14,368 events occurred. Compared to the reference group, participants in the lower LDL-C group had 54.2 per cent lower risk of adverse outcomes, those in the lower SBP group had 44.7 per cent lower risk, and those with combined exposure to lower LDL and lower SBP had 86.1 per cent lower risk.
Researchers noted that the effect was similar in men and women, smokers and nonsmokers, people with and without diabetes, subjects with “normal” baseline LDL-C above and below 3.5 mmol/L, as well as individuals with SBP above and below 120 mm Hg.
Dr Joep Perk of Linnaeus University in Swede, who was a moderator at the press conference, believes that this study shows that drugs can’t replace lifestyle and that physicians should help patients in that direction.