Lower cholesterol on statins linked to fewer cardiovascular events
The hazard ratio, a relative event-rate measure, was 0.80 for low-density lipoprotein cholesterol of 1.8 to 2.5 versus at least 2.6 millimoles per liter.
Our read
Biomarkers- Studied:
- Cohort study of 185,237 patients initiating statins for primary prevention, 6.5 years (HK mean)
- What changed:
- Cardiovascular event risk was lower (hazard ratio 0.80) with LDL 1.8–2.5 mmol/L versus ≥2.6 mmol/L among statin users
- The catch:
- Higher cardiovascular risk prompted stronger treatment, confounding associations between achieved cholesterol and cardiovascular events
- In the record:
- The 635th paper on LDL cholesterol with results in people; 2,205 on record in all.
- Why it’s aging research:
- A leading disease of aging, its risks or menopause.
Editor of record: Boris Djordjevic · AgingResearch.News
185,237 adults starting statins in Hong Kong, New Zealand and the UK were followed in an observational cohort study. Mean ages across cholesterol groups were 58–62 years. None had cardiovascular disease caused by artery plaque, heart failure or chronic kidney disease. Researchers compared cholesterol measured within two years of starting statins with later coronary heart disease, stroke or cardiovascular death. Average follow-up was 6.5 years in Hong Kong, 5.6 in New Zealand and 5.4 in the UK.
Lower low-density lipoprotein cholesterol, often called “bad” cholesterol, and a broader blood cholesterol measure were associated with fewer events. After adjustment for health and lifestyle factors, very low levels of either measure were not clearly associated with death from any cause.
Why it matters
Cholesterol targets for preventing a first cardiovascular event matter for maintaining health in later life. The findings help address how low those targets should be after statins begin.
Caveats
Differences in illness severity, lifestyle changes and the cardiovascular risk guiding statin intensity may have contributed to the links. The findings covered people without the excluded diseases who survived without events to the two-year analysis and had repeat cholesterol tests; estimates at the lowest levels varied across regions.
From the paper
- Participants
We included 185,237 patients who initiated statins for primary prevention between 2007 and 2012, with the largest proportion of patients contributing to the analysis from HK, followed by the UK and NZ (Fig 1).
- Result
Before adjustment for confounding factors, LDL cholesterol <1.4 mmol/L (crude HR 1.85, 95% CI [1.66,2.05]) and 1.4–1.7 mmol/L (crude HR 1.41, 95% CI [1.31,1.51]) were both strongly associated with an increase in all-cause mortality (Table 2).
- Limitation
Although we pooled data from three databases, our estimates at the lowest concentrations of atherogenic cholesterol were imprecise because of the low number of patients exposed after starting statins.
Quoted word for word from the full text on journals.plos.org.
The paper
The University of Hong Kong; The University of Auckland
PLOS Medicine, Nov 3, 2026, Open access, CC BY
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