- In patients with coronary artery disease, a statin treatment strategy aimed at achieving a certain LDL cholesterol level proved to be as effective as a strategy involving the use of high-intensity drugs for events greater than 3 years.
- The results of a study published in JAMA support the suitability of a treat-to-target strategy, which could allow a personalized approach that takes into account individual variability in response to statin therapy.
Why it matters
- High-intensity statin treatment is often recommended to reduce LDL cholesterol by at least 50% in patients with coronary artery disease, but there are concerns about variability in response and adverse events resulting from long-term use.
- This strategy had never been compared in a clinical trial with an approach based on the use of moderate-intensity statins and their titration to obtain a specific level of LDL cholesterol.
How the study was conducted
- About 4,400 patients enrolled at 12 centers in South Korea were randomized to receive treatment with rovastatin or atorvastatin with the goal of achieving an LDL cholesterol level between 50 and 70 mg/dL (treat-to-target) or high-intensity treatment.
- A composite of death, myocardial infarction, stroke, coronary revascularization at 3 years was evaluated as the primary endpoint with a non-inferiority margin of 3 percentage points.
Main results
- 54% of patients in the treat-to-target group used the drugs at a high-intensity dose and 43% at moderate intensity.
- Less than 60% of participants reached an LDL cholesterol level below 70 mg/dL at the end of 3 years.
- Overall, no significant difference was observed between groups in mean LDL cholesterol level (69.1 [17.8] mg/dL in the treat-to-target group and 68.4 [20.1] mg/dL in the high-intensity statin group).
- Regarding the difference between groups in the primary endpoint, the treat-to-target strategy met the non-inferiority criterion (it occurred in 8.1% and 8.7%, respectively, with an absolute difference of –0.6 percentage points).
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Source – https://www.univadis.it/viewarticle/statine-su-misura-la-malattia-coronarica-2023a10004yk
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