Association between delayed statin initiation after high LDL-cholesterol detection and cardiovascular risk in general health screening examinees

Abstract

Aims Additional epidemiological evidence is warranted regarding the appropriate timing of statin initiation for incidentally found dyslipidaemia in general health check-ups. This study examined the association between the statin initiation timing and the risk of myocardial infarction (MI) in individuals with incidentally detected high low-density-lipoprotein cholesterol (LDL-C). Methods and results Participants aged 20 years or older who underwent annual health check-ups from 2009 to 2012 were included. The study population was categorized by statin initiation timing, using progressively delayed initiation intervals following the incidental detection of elevated LDL-C levels. The primary outcome was incident MI. Cox proportional hazards models were used to estimate MI risk for each treatment group compared with the normolipaemic group, and a linear trend across treatment groups was assessed. During a median follow-up of 10.4 years, a total of 5058 events of MI were identified among 508 284 participants included in the study. More delayed statin initiation was associated with a higher risk of MI, with the 3rd year treatment group showing the highest risk compared with the normolipaemic group [HR 1.61 (1.37, 1.89); P for trend < 0.001]. The significantly increasing trend in MI risk with progressively delayed statin initiation remained consistent in stratified and sensitivity analyses. The association was more pronounced among individuals of young age, male, or those without baseline diabetes. Conclusion Delayed initiation of statins following incidental detection of high LDL-C in general health screenings was associated with a progressively higher risk of MI. This association was more pronounced among younger individuals, males, or those without baseline diabetes.