More intensive use of cholesterol-lowering medications to achieve lower low-density lipoprotein cholesterol (LDL-C) targets reduced major cardiovascular events by one-third among patients with atherosclerotic cardiovascular disease, according to findings presented at the American College of Cardiology's Annual Scientific Session on Mar. 28.
The study addresses an important gap in evidence for treating high-risk heart disease patients. While recent guidelines have recommended reducing LDL-C targets from less than 70 mg/dL to less than 55 mg/dL, direct evidence comparing these two goals has been limited until now.
Researchers enrolled over 3,000 patients with atherosclerotic cardiovascular disease at sites across South Korea. Participants were randomly assigned to treatment targeting either below 55 mg/dL or below 70 mg/dL of LDL-C using statins and other therapies as needed. After three years, those in the more aggressive group had significantly fewer composite events—such as cardiovascular death, nonfatal heart attack, stroke, revascularization procedures or hospitalization for unstable angina—than those in the higher target group (6.6% vs. 9.7%).
"The consistency across the overall population and key subgroups suggests that the benefit of targeting LDL-C lower than 55 mg/dL is broadly applicable across the spectrum of patients with ASCVD and is not limited to specific patient subsets," Kim said. The safety profile was similar between groups; muscle symptoms and new-onset diabetes rates did not differ significantly.
The trial was conducted entirely in South Korea among East Asian participants, which may limit its applicability elsewhere due to differences in risk profiles and therapy patterns. Additionally, nearly four out of ten patients in the intensive group did not reach their target due to limitations on available therapies during the study period.
Kim said that broader use of newer non-statin therapies could further improve outcomes for high-risk patients. The research was funded by the Cardiovascular Research Center under contract with Yuhan Corporation and published online simultaneously in the New England Journal of Medicine.
