Which Initial Statin Strategy for Patients with Coronary Artery Disease?

Treating to a target LDL-cholesterol level <70 mg/dL was noninferior to a high-intensity statin strategy in preventing major clinical outcomes.

One guideline-recommended approach to initial statin treatment for patients at high cardiovascular risk is to use a high-intensity statin to lower LDL-cholesterol (LDL-c) by at least 50%. The LODESTAR multicenter, open-label, randomized trial, involving patients with coronary artery disease (CAD) in South Korea, assessed the noninferiority of an alternative approach: Begin with a lower-intensity statin, and titrate the dose as needed to achieve a specific LDL-c target.

In all, 4400 patients (mean age, 65 years; 28% women) were randomized to either the high-intensity statin strategy (rosuvastatin 20 mg/day or atorvastatin 40 mg/day) or the treat-to-target strategy (target LDL-c, ≥50 to <70 mg/dL). During the 3-year study, mean LDL-c was 68.4 …

Reviewing Author

Karol E. Watson, MD, PhD, FACC

Disclosures

Consultant/Advisory BoardBoehringer Ingelheim; Amgen; Novartis; Lilly; Amarin

Speaker’s BureauBoehringer Ingelheim

Grant/Research SupportNIH

Editorial BoardsCirculation (Associate Editor)