Abstract 3860: Statin Use in Patients with Extremely Low LDL Levels is Associated with Improved Survival
Introduction: Aggressive lipid lowering is quickly becoming standard of care for patients with cardiovascular disease. The long-term safety of statin use in those with extremely low LDL levels is less clear.
Methods: We identified 6107 consecutive patients seen at the Palo Alto VA Medical Center or 1 of 7 community clinics with an LDL levels less than 60 mg/dL. Statin therapy was defined as any prescription during the 150 days following the low LDL. A propensity score using history and lab data was used to adjust proportional hazards analyses to determine the association of statin therapy and survival beginning 150 days following the low LDL.
Results: 4960 (74%) patients received at least one prescription and survived during the 5 months following the low LDL value and formed the study cohort. Their mean age was 66 years, 2165 (44%) had prior ischemic heart disease, 2389 (48%) had diabetes and 977 (20%) had a prior malignancy. Statins were used in 2731 (55%). During a mean follow-up of 730 +/−544 days, there were 624 deaths. Unadjusted survival was greater for those treated with statins (fig⇓). After controlling for the propensity to receive a statin, statin therapy remained associated with improved survival (hazard Ratio 0.67, 95%CI 0.56 – 0.80). Benefit from statins was also observed for patients with extremely low LDL levels (< 40mg/dl, N = 700, HR 0.63, CI 0.4 – 0.96), and those without a history of ischemic heart disease (HR 0.47, CI 0.35– 0.63). Statin use was not associated with an observable increase in malignancy or rhabdomyolysis (p > 0.5).
Conclusions: Statin therapy in the setting of a very low LDL level appears to be safe and is associated with improved survival.