{"id":"b97450bf6a76","type":"article","url":"https://hartvaat.nl/2018/04/07/statines-en-niet-statine-ldl-verlagers-en-cardiovasculaire-uitkomsten-meta-analy/","title":"Statines en niet-statine LDL-verlagers en cardiovasculaire uitkomsten: meta-analyse","title_en":"Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","niet-statine-therapie","rosuvastatine","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx566","source_url":"https://doi.org/10.1093/eurheartj/ehx566","authors":["Konstantinos C Koskinas","George C M Siontis","Raffaele Piccolo","Dimitris Mavridis","Lorenz Räber","François Mach","Stephan Windecker"],"significance":8,"published":"2018-04-07","source_date":"2018-04-07","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This meta-analysis comparing statins with non-statin LDL-lowering therapies for secondary prevention confirmed that cardiovascular benefit is proportional to the magnitude of LDL cholesterol reduction regardless of the mechanism of lowering, supporting the treat-to-target approach.","created":"2026-07-03T10:27:13Z","updated":"2026-07-03T13:26:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die statines vergeleek met niet-statine LDL-verlagers op cardiovasculaire uitkomsten bij secundaire preventie. Bevestigt dat LDL-verlaging het mechanisme is, ongeacht het middel.","abstract_original":"AIMS: Current evidence on dyslipidaemia management has expanded to novel treatments and very low achieved levels of low-density lipoprotein cholesterol (LDL-C). We sought to compare the clinical impact of more-intensive vs. less-intensive LDL-C lowering by means of statins and currently recommended non-statin medications in secondary prevention. METHODS AND RESULTS: We searched Medline, EMBASE, and Cochrane databases for randomized controlled trials of statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, or bile acid sequestrants with >500 patients followed for ≥1 year. We employed random-effects models using risk ratios (RRs) with 95% confidence intervals (CIs) to compare outcomes. We included 19 trials (15 of statins, 3 of PCSK9 inhibitors, and 1 of ezetimibe) with 152 507 patients randomly assigned to more-intensive (n = 76 678) or less-intensive treatment (n = 75 829). More-intensive treatment was associated with 19% relative risk reduction for the primary outcome, major vascular events (MVEs; RR 0.81, 95% CI 0.77-0.86). Risk reduction was greater across higher baseline levels and greater achieved reductions of LDL-C. The clinical benefit was significant across varying types of more-intensive treatment and was consistent for statins (RR 0.81, 95% CI 0.76-0.86) and non-statin agents (PCSK9 inhibitors and ezetimibe; RR 0.85, 95% CI 0.77-0.94) as active (more-intensive) intervention (P-interaction = 0.38). Each 1.0 mmol/L reduction in LDL-C was associated with 19% relative decrease in MVE. Death, cardiovascular death, myocardial infarction, stroke, and coronary revascularization also favoured more-intensive treatment. CONCLUSION: Reduction of MVE is proportional to the magnitude of LDL-C lowering across a broad spectrum of on-treatment levels in secondary prevention. Statin intensification and add-on treatment with PCSK9 inhibitors or ezetimibe are associated with significant reduction of cardiovascular morbidity in this very high-risk population."}