How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention

HomeCirculationVol. 147, No. 16How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention No AccessEditorialRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toNo AccessEditorialRequest AccessFull TextHow Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention Fatima Rodriguez and Amit Khera Fatima RodriguezFatima Rodriguez https://orcid.org/0000-0002-5226-0723 Department of Internal Medicine, Division of Cardiology and the Cardiovascular Institute, Stanford University, CA (F.A.). Search for more papers by this author and Amit KheraAmit Khera Correspondence to: Amit Khera, MD, MSc, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830. Email E-mail Address: [email protected] https://orcid.org/0000-0001-7255-6874 Department of Internal Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.K.). Search for more papers by this author Originally published17 Apr 2023https://doi.org/10.1161/CIRCULATIONAHA.123.064041Circulation. 2023;147:1204–1207This article is a commentary on the followingAssociation Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLEFootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.For Sources of Funding and Disclosures, see page 1207.Circulation is available at www.ahajournals.org/journal/circCorrespondence to: Amit Khera, MD, MSc, Division of Cardiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8830. Email amit.[email protected]eduReferences1. Cleeman JI, Lenfant C. The National Cholesterol Education Program: progress and prospects.JAMA. 1998; 280:2099–2104. doi: 10.1001/jama.280.24.2099CrossrefMedlineGoogle Scholar2. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019; 139:e1082–e1143. doi: 10.1161/CIR.0000000000000625LinkGoogle Scholar3. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, et al; ESC Scientific Document Group. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.Eur Heart J. 2020; 41:111–188. doi: 10.1093/eurheartj/ehz455CrossrefMedlineGoogle Scholar4. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, Kirby A, Sourjina T, Peto R, Collins R, et al; Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.Lancet. 2005; 366:1267–1278. doi: 10.1016/S0140-6736(05)67394-1CrossrefMedlineGoogle Scholar5. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S).Lancet. 1994; 344:1383–1389.MedlineGoogle Scholar6. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, Brown L, Warnica JW, Arnold JM, Wun CC, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events Trial investigators.N Engl J Med. 1996; 335:1001–1009. doi: 10.1056/NEJM199610033351401CrossrefMedlineGoogle Scholar7. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM; Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes.N Engl J Med. 2004; 350:1495–1504. doi: 10.1056/NEJMoa040583CrossrefMedlineGoogle Scholar8. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H, Lewis BS, Ophuis TO, Jukema JW, et al; IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015; 372:2387–2397. doi: 10.1056/NEJMoa1410489CrossrefMedlineGoogle Scholar9. Sabatine MS, Giugliano RP, Keech AC, Honarpour N, Wiviott SD, Murphy SA, Kuder JF, Wang H, Liu T, Wasserman SM, et al; FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease.N Engl J Med. 2017; 376:1713–1722. doi: 10.1056/NEJMoa1615664CrossrefMedlineGoogle Scholar10. Schwartz GG, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, Edelberg JM, Goodman SG, Hanotin C, Harrington RA, et al; ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and cardiovascular outcomes after acute coronary syndrome.N Engl J Med. 2018; 379:2097–2107. doi: 10.1056/NEJMoa1801174CrossrefMedlineGoogle Scholar11. Giugliano RP, Pedersen TR, Park JG, De Ferrari GM, Gaciong ZA, Ceska R, Toth K, Gouni-Berthold I, Lopez-Miranda J, Schiele F, et al; FOURIER Investigators. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial.Lancet. 2017; 390:1962–1971. doi: 10.1016/S0140-6736(17)32290-0CrossrefMedlineGoogle Scholar12. Gaba P, O’Donoghue ML, Park J-G, Wiviott SD, Atar D, Kuder JF, Im K, Murphy SA, De Ferrari GM, Gaciong ZA, et al. Association between achieved low-density lipoprotein cholesterol levels and long-term cardiovascular and safety outcomes: an analysis of FOURIER-OLE.Circulation. 2023; 147:1192–1203. doi: 10.1161/CIRCULATIONAHA.122.063399LinkGoogle Scholar13. Giugliano RP, Wiviott SD, Blazing MA, De Ferrari GM, Park JG, Murphy SA, White JA, Tershakovec AM, Cannon CP, Braunwald E. Long-term safety and efficacy of achieving very low levels of low-density lipoprotein cholesterol: a prespecified analysis of the IMPROVE-IT trial.JAMA Cardiol. 2017; 2:547–555. doi: 10.1001/jamacardio.2017.0083CrossrefMedlineGoogle Scholar14. Lloyd-Jones DM, Morris PB, Ballantyne CM, Birtcher KK, Covington AM, DePalma SM, Minissian MB, Orringer CE, Smith SC, Waring AA, et al; Writing Committee. 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee.J Am Coll Cardiol. 2022; 80:1366–1418. doi: 10.1016/j.jacc.2022.07.006CrossrefMedlineGoogle Scholar15. Martin SS, Giugliano RP, Murphy SA, Wasserman SM, Stein EA, Ceška R, López-Miranda J, Georgiev B, Lorenzatti AJ, Tikkanen MJ, et al. Comparison of low-density lipoprotein cholesterol assessment by Martin/Hopkins estimation, Friedewald estimation, and preparative ultracentrifugation: insights from the FOURIER trial.JAMA Cardiol. 2018; 3:749–753. doi: 10.1001/jamacardio.2018.1533CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsRelated articlesAssociation Between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLEPrakriti Gaba, et al. Circulation. 2023;147:1192-1203 April 18, 2023Vol 147, Issue 16 Advertisement Article InformationMetrics © 2023 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.123.064041PMID: 37068134 Originally publishedApril 17, 2023 KeywordsEditorialsPDF download Advertisement SubjectsLipids and CholesterolRisk Factors