Is LDL-C–Lowering Therapy Less Effective for Patients With a Higher BMI?

Among individuals receiving intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapy, those with a higher body mass index (BMI) may not experience as large a clinical impact than those with a normal BMI, according to results of a new study.

“The results could be due to the higher mortality rate of [patients with obesity] that may artificially lower the efficacy of therapy, or due to a true therapeutic limitation in these patients,” the researchers wrote.

To evaluate the association of BMI on cardiovascular (CV) outcomes among patients receiving intensive LDL-C–lowering therapy, the researchers performed a meta-analysis of 29 randomized controlled trials using the PubMed, Embase, and CENTRAL databases through April 2019.

Statins, ezetimibe and statin, or proprotein convertase subtilisin/kexin type 9 inhibitors were grouped as “more-intensive LDL-C–lowering therapies.” Less-potent active control or placebo were grouped as “less-intensive LDL-C–lowering therapies.” 

The association of BMI with CV endpoints was evaluated using data from 265,766 participants in the included trials. Among these patients, for every 1 kg/m2 increase in BMI, more-intensive therapy compared with less-intensive therapy was associated with hazard ratio of:

  • 1.07 for CV mortality
  • 1.03 for all-cause mortality
  • 1.06 for myocardial infarction
  • 1.08 for revascularization
  • 1.04 for major adverse CV events


According to the meta-analysis, patients with a BMI less than 25 kg/m2 had the highest risk reduction in mortality and CV outcomes compared with patients with a BMI of 30 kg/m2 or greater. 

—Colleen Murphy


Khan SU, Khan MU, Riaz H, et al. Meta-analysis of the relation of body mass index to cardiovascular outcomes in patients receiving intensive low-density lipoprotein cholesterol lowering therapy. Am J Cardiol. 2020;125(5):727-734.