In patients with arteriosclerotic cardiovascular disease, there is no difference such as occurrence of diabetes and elevated hepatic enzyme
Studies have shown that treatment strategies that more aggressively lower LDL cholesterol targets in patients with atherosclerotic cardiovascular disease may reduce cardiovascular events more effectively. Maintaining 55 mg/dL from the existing 70 mg/dL reduced the incidence of major cardiovascular events by more than 30%.
A research team led by Kim Byung-keuk, Lee Yong-joon, and Lee Seung-joon of Yonsei University Severance Hospital’s cardiology department announced on the 30th that they published the findings in the international journal “New England Journal of Medicine.”
Patients with arteriosclerotic cardiovascular disease are high-risk groups with a high risk of recurrence of major cardiovascular events such as myocardial infarction or stroke. The key goal of treatment for dyslipidemia in these patients is to lower LDL cholesterol. Previously, studies have been conducted on whether drugs such as high-intensity statin treatment, ezetimibe, and PCSK9 inhibitors can lower cholesterol levels and cardiovascular event risk.
As such, studies so far have focused on evaluating the effectiveness of certain drugs, so studies verifying specific targets for LDL cholesterol have been insufficient. Recent guidelines for treating dyslipidemia suggest that LDL cholesterol targets for patients with arteriosclerotic cardiovascular disease are further lowered from less than 70 mg/dL to less than 55 mg/dL. However, there is no basis for whether these changes in the target value have a real cardiovascular effect.
The research team compared the treatment effectiveness of 3048 patients with arteriosclerotic cardiovascular disease at 17 medical institutions in Korea by dividing the LDL cholesterol target into an intensive target group with an LDL cholesterol target of less than 55 mg/dL and an existing target group with a target of less than 70 mg/dL. Patients in each group were randomly assigned, statin doses were adjusted and etimibed to achieve target LDL cholesterol levels during the follow-up period, and PCSK9 inhibitors were used if necessary.
Three years of follow-up showed that the incidence of major cardiovascular events such as cardiovascular death, myocardial infarction, and stroke was 6.6% in the intensive target group (less than 55 mg/dL), which was more than 30% lower than the previous target group (70 mg/dL) of 9.7%. In particular, the incidence of nonfatal myocardial infarction and vascular revascularization was significantly lower in the intensive target group.
In the safety analysis, there was no difference between the two groups in most adverse reactions, such as new diabetes, worsening blood sugar control, muscle-related side effects, and elevated liver enzymes, and the increase in creatinine related to kidney function was lower than the existing target group at 1.2%.
Professor Kim Byung-keuk said, “This is the first study to prove that a more active LDL cholesterol treatment target strategy in patients with arteriosclerotic cardiovascular disease can lead to a reduction in actual cardiovascular events,” adding, “We expect it to be an important basis for supporting stricter LDL cholesterol targets presented in the current dyslipidemia treatment guidelines.”