Strategy noninferior for three-year composite of death, myocardial infarction, stroke, or coronary revascularization
By Elana Gotkine HealthDay Reporter
TUESDAY, March 7, 2023 (HealthDay News) — For patients with coronary artery disease, a treat-to-target low-density lipoprotein cholesterol (LDL-C) strategy is noninferior to high-intensity statin therapy, according to a study published online March 6 in the Journal of the American Medical Association to coincide with the annual meeting of the American College of Cardiology, held from March 4 to 6 in New Orleans.
Sung-Jin Hong, M.D., from the Yonsei University College of Medicine in Seoul, South Korea, and colleagues examined whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term outcomes among patients with coronary artery disease from 12 centers. Participants were randomly assigned to receive the treat-to-target strategy, with a target LDL-C level between 50 and 70 mg/dL or high-intensity statin treatment of 20 mg rosuvastatin or 40 mg atorvastatin.
A total of 4,400 patients were enrolled (2,200 in the treat-to-target group, with 6,449 person-years of follow-up). The researchers found that moderate-intensity and high-intensity dosing were used in 43 and 54 percent of patients in the treat-to-target group. The mean LDL-C level for three years was 69.1 and 68.4 mg/dL in the treat-to-target and high-intensity statin groups, respectively. The primary end point (three-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points) occurred in 8.1 and 8.7 percent of patients in the treat-to-target and high-intensity statin groups, respectively.
“These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy,” the authors write.
One author disclosed financial ties to the pharmaceutical and medical device industries.
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