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. 2023 Sep;112(9):1212-1219.
doi: 10.1007/s00392-022-02147-3. Epub 2023 Jan 5.

Intensive lipid-lowering therapy for early achievement of guideline-recommended LDL-cholesterol levels in patients with ST-elevation myocardial infarction ("Jena auf Ziel")

Umidakhon Makhmudova  1 , Beasat Samadifar  1 , Aurel Maloku  1 , Pellumb Haxhikadrija  1 , Jens-Arndt Geiling  1 , Robert Römer  1 , Bernward Lauer  1 , Sven Möbius-Winkler  1 , Sylvia Otto  1 , P Christian Schulze  1 , Oliver Weingärtner  2
Affiliations

Intensive lipid-lowering therapy for early achievement of guideline-recommended LDL-cholesterol levels in patients with ST-elevation myocardial infarction ("Jena auf Ziel")

Umidakhon Makhmudova et al. Clin Res Cardiol. 2023 Sep.

Abstract

Background and aims: Currently, less than 20% of patients at very high-risk achieve ESC/EAS dyslipidemia guideline-recommended LDL-C target levels in Europe. "Jena auf Ziel-JaZ" is a prospective cohort study in which early combination therapy with atorvastatin 80 mg and ezetimibe 10 mg was initiated on admission in patients with ST-elevation myocardial infarction (STEMI) and lipid-lowering therapy was escalated during follow-up with bempedoic acid and PCSK9 inhibitors to achieve recommended LDL-C targets in all patients. Moreover, we evaluated side-effects of lipid-lowering therapy.

Methods: Patients admitted with STEMI at Jena University Hospital were started on atorvastatin 80 mg and ezetimibe 10 mg on admission. Patients were followed for EAS/ESC LDL-C target achievement during follow-up.

Results: A total of 85 consecutive patients were enrolled in the study. On discharge, 32.9% achieved LDL-C targets on atorvastatin 80 mg and ezetimibe 10 mg. After 4-6 weeks, 80% of all patients on atorvastatin 80 mg and ezetimibe started at the index event were on ESC/EAS LDL-C targets. In 20%, combined lipid-lowering therapy was escalated with either bempedoic acid or PCSK9 inhibitors. All patients achieved LDL-C levels of or below 55 mg/dL during follow-up on triple lipid-lowering therapy. Combined lipid-lowering therapy was well-tolerated with rare side effects.

Conclusions: Early combination therapy with a high-intensity statin and ezetimibe and escalation of lipid-lowering therapy with either bempedoic acid or PCSK9 inhibitors gets potentially all patients with STEMI on recommended ESC/EAS LDL-C targets without significant side effects.

Keywords: LDL cholesterol; LDL cholesterol target attainment; ST-elevation myocardial infarction; Secondary prevention.

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Conflict of interest statement

U.M. reports speaker fee and travel support from the German Lipid Association (DGFF), honoraria for advisory board from Sanofi and non-monetary cooperation with Novartis. O.W. received honoraria and travel support from AMGEN, Daiichi-Sankyo, Amarin, Novo Nordisk, Novartis, Hexal GmbH, Sanofi-Aventis, Fresenius, Akcea Therapeutics, TAD Pharma, and the German Cardiac Society (DGK). He received honoraria for advisory boards from AMGEN, Sanofi-Aventis, Novartis, Daiichi-Sankyo, Hexal GmbH, Akcea Therapeutics, the German Cardiac Society (DGK) and Pfizer. P.C.S. received honoraria and travel support from Bayer, Astra Zeneca, Daiichi Sankyo, Novartis, Actelion, Roche, Sanofi Aventis, Pharmacosmos, Medtronic, Thoratec, Boehringer Ingelheim, Heartware, Coronus, Abbott, Edwards Inc., Boston Scientific, St. Jude Medical, Abiomed, and the German Cardiac Society (DGK). He received research support from the National Institute of Health (USA), the German Research Foundation, the Else Kröner Fresenius Foundation, German Heart Foundation, the European Society of Cardiology, Actelion, Medtronic, BMBF, Abiomed, Boehringer Ingelheim and Boston Scientific. He served on advisory boards for the German Research Council, Eurotransplant, Novartis, Bayer, Pharmacosmos, Astra Zeneca, Boehringer Ingelheim Inc., the German Cardiac Society and the European Society of Cardiology. Other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
JaZ—study flow. Patients started on atorvastatin 80 mg/ezetimibe 10 mg combination therapy on admission. LDL-C is measured on admission, on discharge, after 6–8 weeks and during further follow-ups. Patient empowerment is used to increase therapy adherence
Fig. 2
Fig. 2
Study diagram in accordance with the STROBE checklist
Fig. 3
Fig. 3
A LDL-C levels at baseline, discharge, first follow-up, and “on target” are presented as individual data points. B LDL-C levels on baseline and “on target” are shown as individual changes
Fig. 4
Fig. 4
Graphical visualization of LDL-C target (< 1.4 mmol/L) attainment. BA bempedoic acid, PCSK9 mab PCSK9 monoclonal antibody. To convert mmol/L to mg/dL, multiply by 38.66976. Data are shown as mean and SD
See this image and copyright information in PMC

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