Background
Methods
The Multi-Ethnic Study of Atherosclerosis (MESA) data
Imputation model
Observations | Y = Pre-treated cholesterol | X = Post-treated cholesterol | Z = Covariates |
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New lipid-lowering medication users (N = 1286) | Exam dependent cholesterol levels (exam prior to starting lipid-lowering medication) | Exam dependent cholesterol levels (exam after starting lipid-lowering medication) | Exam dependent covariates (exam after starting lipid-lowering medication) |
Lipid-lowering medication users at baseline (N = 1086) | Missing | Post-treated cholesterol from exam 1 | Baseline covariates from exam 1 |
Propensity score model
Endpoint models
Results
Baseline statin use | ||||||
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Non-weighted | Weighted using stabilized IPTW1
| |||||
Characteristics | No (N = 5150) | Yes (N = 885) | No (N = 5150) | Yes (N = 885) | ||
Mean (SD) or n (%) | Mean (SD) or n (%) | P-value | Mean (SD) or n (%) | Mean (SD) or n (%) | P-value | |
Age, Mean (SD), y | 61.3 (10.3) | 65.9 (8.8) | <.001 | 62.0 (10.2) | 62.9 (9.7) | 0.141 |
Male | 2441 (47.4%) | 417 (47.1%) | 0.879 | 2530 (47.7%) | 401 (50.8%) | 0.308 |
Race/ethnicity | ||||||
White | 1976 (38.4%) | 385 (43.5%) | 0.004 | 2069 (39.0%) | 351 (44.5%) | 0.156 |
Chinese | 672 (13.1%) | 99 (11.2%) | 650 (12.3%) | 74 (9.4%) | ||
Black | 1323 (25.7) | 235 (26.6%) | 1355 (25.6%) | 186 (23.6%) | ||
Hispanic | 1179 (22.9%) | 166 (18.8%) | 1226 (23.1%) | 178 (22.6%) | ||
Body mass index, kg/m2
| 28.1 (5.5) | 28.7 (5.0) | <.001 | 28.2 (5.4) | 28.5 (5.2) | 0.235 |
Current smoker | 690 (13.4%) | 83 (9.4%) | 0.001 | 659 (12.4%) | 84 (10.6%) | 0.394 |
Pack years smoking | 11.0 (22.3) | 12.9 (22.4) | 0.021 | 11.1 (22.2) | 10.9 (21.5) | 0.880 |
Current alcohol use | 2902 (56.4%) | 507 (57.3%) | 0.603 | 2997 (56.5%) | 479 (60.7%) | 0.128 |
Diabetes | 534 (10.4%) | 191 (21.6%) | <.001 | 729 (13.8%) | (111 (14.0%) | 0.897 |
Family history of MI | 1952 (37.9%) | 427 (48.3%) | <.001 | 2153 (59.4%) | 334 (42.4%) | 0.542 |
Hypertension | 2082 (40.4%) | 543 (61.4%) | <.001 | 2301 (43.4%) | 358 (45.3%) | 0.492 |
Hypertension Meds | 1645 (32.0%) | 520 (58.8%) | <.001 | 1941 (36.6%) | 309 (39.2%) | 0.323 |
Total cholesterol, mg/dL | 196.7 (35.7) | 224.1 (36.4) | <.001 | 206.4 (50.9) | 204.4 (41.2) | 0.611 |
Systolic BP, mm Hg | 125.5 (21.3) | 129.7 (21.6) | <.001 | 126.1 (21.1) | 127.3 (22.3) | 0.286 |
Diastolic BP, mm Hg | 72.0 (10.4) | 71.2 (9.6) | 0.038 | 71.9 (10.3) | 72.0 (9.9) | 0.727 |
Health insurance | 4644 (90.2%) | 861 (97.3%) | <.001 | 4789 (90.4%) | 741 (93.9%) | 0.109 |
Income | ||||||
<$25 K | 1586 (30.8%) | 285 (32.2%) | 0.165 | 1679 (31.7%) | 229 (29.0%) | 0.592 |
$25 K-$49 K | 1492 (29.0%) | 250 (28.3%) | 1558 (29.4%) | 237 (30.0%) | ||
$50 K-$99 K | 1375 (26.7%) | 212 (24.0%) | 1351 (25.5%) | 198 (25.1%) | ||
$100 K+ | 697 (13.5%) | 138 (15.6%) | 712 (13.4%) | 125 (15.9%) | ||
Education | ||||||
< High school | 914 (17.8%) | 143 (16.2%) | 0.164 | 941 (17.8%) | 124 (15.7%) | 0.381 |
High school | 2352 (45.7%) | 420 (47.5%) | 2475 (46.7%) | 366 (46.4) | ||
College | 937 (18.2%) | 142 (16.1%) | 914 (17.3%) | 124 (15.8%) | ||
Graduate school | 947 (18.4%) | 180 (20.3%) | 970 (18.3%) | 174 (22.1%) | ||
Married | 3160 (61.4%) | 546 (61.7%) | 0.850 | 3246 (61.3%) | 502 (63.6%) | 0.406 |
Intentional exercise (met-min/wk) | 1583 (2396) | 1527 (2130) | 0.480 | 1644 (2421) | 1692 (2477) | 0.705 |
Creatinine, mg/dL | 0.94 (0.23) | 1.01 (0.41) | <.001 | 0.97 (0.31) | 0.97 (0.30) | 0.778 |
Fibrinogen, mg/dL | 342.6 (72.8) | 357.4 (74.6) | <.001 | 351.3 (83.8) | 356.4 (88.0) | 0.530 |
hs-CRP, mg/L | 3.7 (5.8) | 3.2 (4.8) | 0.004 | 3.6 (5.4) | 4.2 (7.3) | 0.396 |
CAC (Agatston) | 122 (367) | 240 (522) | <.001 | 149 (400) | 161 (444) | 0.525 |
Common carotid (mm) | 0.86 (0.19) | 0.91 (0.19) | <.001 | 0.87 (0.19) | 0.88 (0.19) | 0.195 |
Internal carotid (mm) | 1.03 (0.57) | 1.25 (0.67) | <.001 | 1.08 (0.61) | 1.13 (0.66) | 0.139 |
Heart rate (bpm) | 63.0 (9.5) | 63.6 (9.8) | 0.066 | 63.3 (9.8) | 63.8 (10.4) | 0.455 |
Adjusted R2 = 0.44 | Cholesterolpre-treated(N = 1286) | ||
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Covariates |
β
| (95% CI) | P-value |
Cholesterolpost-treated (mg/dl) | 0.53 | (0.46,0.60) | <.001 |
Age (years) | -0.18 | (-0.35,-0.01) | 0.033 |
Gender – Male | -10.32 | (-13.66,-6.98) | <.001 |
Race/ethnicity | |||
White | -- | -- | -- |
Chinese | -6.21 | (-11.71,-0.72) | 0.027 |
Black | -7.62 | (-11.63,-3.60) | <.001 |
Hispanic | -1.21 | (-5.32,2.90) | 0.565 |
Diabetes | |||
Normal | -- | -- | -- |
IFG | 0.23 | (-3.80,4.26) | 0.910 |
Untreated diabetes | 2.69 | (-9.46,14.85) | 0.664 |
Treated diabetes | -9.00 | (-12.91,-5.10) | <.001 |
Hypertension Meds – Yes | -5.43 | (-8.79,-2.08) | 0.002 |
HDLpost-treated
| 0.12 | (-0.03,0.26) | 0.107 |
triglycerides | 0.03 | (-0.00,0.05) | 0.069 |
Atorvastatin | |||
Yes – Low dose | 28.31 | (18.19,38.42) | <.001 |
Yes – High dose | 42.84 | (31.99,53.69) | <.001 |
Fluvastatin | |||
Yes – Low dose | 18.24 | (1.01,35.47) | 0.038 |
Yes – High dose | 25.83 | (13.15,38.51) | <.001 |
Lovastatin | |||
Yes – Low dose | 19.41 | (8.61,30.21) | <.001 |
Yes – High dose | 34.80 | (20.87,48.74) | <.001 |
Pravastatin | |||
Yes – Low dose | 20.23 | (8.69,31.77) | 0.001 |
Yes – High dose | 23.72 | (8.71,38.73) | 0.002 |
Simvastatin | |||
Yes – Low dose | 45.46 | (22.98,67.94) | <.001 |
Yes – High dose | 19.16 | (-16.64,54.96) | 0.294 |
Simvastatin*Cholesterolpost-treated Interaction | |||
Yes – Low dose | -0.12 | (-0.25,0.01) | 0.071 |
Yes – High dose | 0.11 | (-0.11,0.32) | 0.320 |
Rosuvastatin – Yes | 38.36 | (26.43,50.29) | <.001 |
Fibrate – Yes | 7.00 | (-3.76,17.77) | 0.202 |
Resin – Yes | -7.76 | (-31.48,15.96) | 0.521 |
Niacin – Yes | -29.12 | (-56.25,-2.00) | 0.035 |
Niacin*Cholesterolpost-treated Interaction | 0.12 | (-0.02,0.27) | 0.101 |
Ezetimibe – Yes | 12.10 | (2.27,21.94) | 0.016 |
CHD, Hard | CVD, Hard | |||
---|---|---|---|---|
(Events = 119) | (Events = 190) | |||
Model (N = 6035) | HR (95% CI) | p-value | HR (95% CI) | p-value |
Unweighted
1
| 0.97 (0.60,1.59) | 0.915 | 0.92 [0.62,1.36] | 0.676 |
Weighted
| ||||
Propensity model
| ||||
No cholesterol | 0.92 [0.54,1.57] | 0.767 | 0.82 [0.54,1.26] | 0.373 |
Imputed cholesterol2
| 0.74 [0.38,1.42] | 0.363 | 0.72 [0.43,1.21] | 0.215 |
New-user analysis (N = 4886) | 0.91 [0.45,1.80] (Events = 100) | 0.777 | 0.71 [0.38,1.30] (Events = 153) | 0.265 |
Sensitivity analysis3
| ||||
No truncating | 0.59 [0.27,1.32] | 0.199 | 0.62 [0.34,1.15] | 0.130 |
<.2 & >20 | 0.68 [0.34,1.36] | 0.275 | 0.69 [0.40,1.17] | 0.166 |
<.3 & >30 | 0.64 [0.30,1.34] | 0.238 | 0.66 [0.38,1.16] | 0.152 |
<.3 & >10 | 0.74 [0.39,1.42] | 0.370 | 0.73 [0.44,1.21] | 0.220 |