Mortality reduction in patients treated with long-term intensive lipid therapy: 25-year follow-up of the Familial Atherosclerosis Treatment Study-Observational Study.
Cardiovascular disease (CVD) begins early in life and is associated with both the number of risk factors present and length of exposure to these risk factors including hyperlipidemia.



The clinical benefit of intensive lipid therapy over 25 years was investigated in the Familial Atherosclerosis Treatment Study-Observational Study.



Of 175 coronary artery disease subjects with mean low-density lipoprotein cholesterol (LDL-C) of 191 mg/dL and mean age of 50 years, who completed the randomized and placebo-controlled Familial Atherosclerosis Treatment Study, 100 chose receiving lipid management by their physicians (usual care [UC]) and 75 elected to receive an intensive treatment [IT] for lipid management with lovastatin (40 mg/d), niacin (2.5 g/d), and colestipol (20 g/d) from 1989 to 2004, followed by double therapy with simvastatin (40-80 mg/d) and niacin from 2005 to 2006 and by triple therapy of ezetimibe 10 mg and simvastatin 40 to 80 mg/d plus niacin during 2007 to 2012. Deaths from CVD, non-CVD, and any cause were compared between UC and IT using Cox proportional hazards model.



UC and IT groups were similar in risk factors with the exception that IT had more severe coronary artery disease. Mean LDL-C levels were 167 mg/dL from 1988 to 2004, 97 from 2005 to 2006, and 96 from 2007 to 2012 in surviving subjects receiving UC. IT lowered LDL-C to 119, 97, and 83 mg/dL in the 3 periods, respectively. Compared with UC, IT significantly reduced total mortality (11.1 vs 26.3 per 1000 person years [PY], hazard ratio [HR] = 0.45, 95% confidence interval [CI]: 0.26-0.77, P = .003) and CVD mortality (10.6 vs 27.7 per 1000 PY, HR = 0.34, 95% CI: 0.15-0.80, P = .009). The non-CVD mortality was also reduced but was not of statistical significance (6.8 vs 12.7 per 1000 PY, HR = 0.55, 95% CI: 0.27-1.14, P = .11).



Long-term intensive lipid therapy significantly reduced total and cardiovascular mortality in Familial Atherosclerosis Treatment Study-Observational Study. These results support the importance of lifetime risk management to improve long-term outcome.
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA. Electronic address: xueqiao@uw.edu.
Xue-Qiao
XQ
Zhao
Division of Cardiology, San Francisco General Hospital, University of California, San Francisco, ​San Francisco, CA, USA.
Binh An P
BA
Phan
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
Joseph
J
Davis
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
Daniel
D
Isquith
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
Alice A
AA
Dowdy
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
Suzanne
S
Boltz
Mountain-Whisper-Light Statistics, Seattle, WA, USA.
Moni
M
Neradilek
Yakima Heart Center, Yakima, WA, USA.
Erik A
EA
Monick
UW Medicine - Valley Medical Center, Renton, WA, USA.
Andrew
A
Brockenbrough
Virginia Mason Medical Center, Seattle, WA, USA.
Ellen E
EE
Hus-Frechette
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
John J
JJ
Albers
Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA.
B Greg
BG
Brown
D000328:Adult; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000188:drug therapy* / Q000401:mortality; D001384:Azetidines / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003084:Colestipol / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008148:Lovastatin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use; D016016:Proportional Hazards Models; D019821:Simvastatin / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
D000924:Anticholesteremic Agents; D001384:Azetidines; D008078:Cholesterol, LDL; D014280:Triglycerides; D009525:Niacin; D008148:Lovastatin; D019821:Simvastatin; D003084:Colestipol
Cardiovascular disease; Lifetime risk; Lipid-lowering therapy; Mortality
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