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Guidelines recommend that patients with coronary artery disease take high-intensity statins to lower LDL cholesterol levels by ≥50%, but they do not specify which statin to select or whether initiating a lower dose and titrating up (based on response) is acceptable (NEJM JW Gen Med Feb 1 2019 and J Am Coll Cardiol 2019; 73:3168). In 2023, two reports from the same trial provided insight into these considerations.
In the LODESTAR trial, researchers randomized 4400 patients in South Korea with preexisting coronary artery disease to two strategies for statin treatment. One group received daily high-intensity statins (20-mg rosuvastatin or 40-mg atorvastatin); in the other group (treat-to-target group), lower doses (10-mg rosuvastatin or 20-mg a…