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Targeting an LDL cholesterol level of <55 mg/dL significantly reduced the risk of cardiovascular events at 3 years compared to <70 mg/dL (HR 0.67; 95% CI 0.52-0.86; P=0.002).
RCT
1:1
Open-label
Does targeting an LDL cholesterol level of less than 55 mg/dL reduce cardiovascular events compared to targeting less than 70 mg/dL in patients with atherosclerotic cardiovascular disease?
3,048 patients with atherosclerotic cardiovascular disease in South Korea
Target LDL cholesterol level of less than 55 mg per deciliter (1.4 mmol per liter)
Target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter)
Composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or hospitalization for unstable angina at 3 yearscomposite
In patients with atherosclerotic cardiovascular disease, an intensive LDL cholesterol target of <55 mg/dL significantly reduces the risk of major adverse cardiovascular events at 3 years compared to a conventional target of <70 mg/dL.
BACKGROUND: Despite guideline recommendations, evidence from randomized trials evaluating the appropriate low-density lipoprotein (LDL) cholesterol target for secondary prevention in patients with atherosclerotic cardiovascular disease remains limited. METHODS: In this open-label superiority trial conducted in South Korea, we randomly assigned patients with atherosclerotic cardiovascular disease in a 1:1 ratio to a target LDL cholesterol level of less than 55 mg per deciliter (1.4 mmol per liter) (intensive-targeting group) or less than 70 mg per deciliter (1.8 mmol per liter) (conventional-targeting group). The primary end point was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or hospitalization for unstable angina at 3 years. Safety was also assessed. RESULTS: Of 3048 patients who underwent randomization, 1526 were assigned to the intensive-targeting group and 1522 to the conventional-targeting group. The median follow-up was 3.0 years. The median LDL cholesterol level during the trial was 56 mg per deciliter (1.4 mmol per liter) in the intensive-targeting group and 66 mg per deciliter (1.7 mmol per liter) in the conventional-targeting group. A primary end-point event occurred in 100 patients (Kaplan-Meier estimate of cumulative incidence, 6.6%) in the intensive-targeting group and in 147 patients (Kaplan-Meier estimate of cumulative incidence, 9.7%) in the conventional-targeting group (hazard ratio, 0.67; 95% confidence interval, 0.52 to 0.86; P = 0.002). The incidence of prespecified safety end points was similar in the two trial groups, except for a lower incidence of creatinine elevation in the intensive-targeting group. CONCLUSIONS: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level of less than 55 mg per deciliter resulted in a lower risk of cardiovascular events at 3 years than targeting a level of less than 70 mg per deciliter. (Funded by the Cardiovascular Research Center and Yuhan; Ez-PAVE ClinicalTrials.gov number, NCT04626973.).
“This is really saying that 55 is our new goal and we need to really embrace that and work hard to get patients to that goal.”
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Yong-Joon Lee
Seung-Jun Lee
Jin Won Kim
New England Journal of Medicine
Yonsei University
Sungkyunkwan University
Korea University
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Lee et al. (Sat,) conducted a rct in Atherosclerotic cardiovascular disease (n=3,048). Target LDL cholesterol level of less than 55 mg/dL vs. Target LDL cholesterol level of less than 70 mg/dL was evaluated on Composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, any revascularization, or hospitalization for unstable angina at 3 years (HR 0.67, 95% CI 0.52 to 0.86, p=0.002). Targeting an LDL cholesterol level of <55 mg/dL significantly reduced the risk of cardiovascular events at 3 years compared to <70 mg/dL (HR 0.67; 95% CI 0.52-0.86; P=0.002).
www.synapsesocial.com/papers/69ccb55116edfba7beb87410 — DOI: https://doi.org/10.1056/nejmoa2600283
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