{"id":"4c385973eab7","type":"article","url":"https://hartvaat.nl/2016/05/01/procentuele-ldl-verlaging-bij-hoogintensieve-statinetherapie-implicaties-voor-ri/","title":"Procentuele LDL-verlaging bij hoogintensieve statinetherapie: implicaties voor richtlijnen en PCSK9-remmers","title_en":"Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["anemie-ckd","bempedoïnezuur","cetp-remmers","clear-outcomes","diabetes-en-hart","dyslipidemie","enlicitide","ezetimibe","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","farmaco-economie","figaro-dkd","gepersonaliseerde-geneeskunde","hdl-cholesterol","hs-crp","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","obicetrapib","ouderen","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","pelacarsen","perifeer-vaatlijden","richtlijnen-esc","rosuvastatine","soul-trial","statines","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw046","source_url":"https://doi.org/10.1093/eurheartj/ehw046","authors":["Paul M Ridker","Samia Mora","Lynda Rose"],"significance":7,"published":"2016-05-01","source_date":"2016-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/pcsk9-mechanisme/"],"congress":"","summary_en":"This analysis examined the variability in percentage LDL cholesterol reduction achieved with high-intensity statin therapy, showing that a significant proportion of patients fail to achieve the expected ≥50% reduction. The findings have implications for guideline-based LDL target strategies.","created":"2026-07-03T10:26:05Z","updated":"2026-07-03T13:25:26Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de variabiliteit in procentuele LDL-cholesterolreductie bij hoogintensieve statinetherapie. Relevant voor het bepalen welke patiënten baat hebben bij aanvullende PCSK9-remming.","abstract_original":"AIMS: Current statin guidelines in Europe and Canada advocate achieving a fixed LDL target or the attainment of a ≥50% reduction in low-density lipoprotein cholesterol (LDLC), while current US guidelines advocate the use of statin therapies that reduce LDLC by <50% (moderate intensity) or ≥50% (high intensity). Data are limited, however, linking the achievement of these % reduction thresholds to subsequent cardiovascular outcomes particularly for contemporary high-intensity regimens. METHODS AND RESULTS: In a randomized trial of 17 082 initially healthy men and women with median baseline LDLC of 108 mg/dL (interquartile range 94-119), we (i) used waterfall plots to assess the variability in LDLC response to rosuvastatin 20 mg daily and (ii) evaluated the impact of reaching ≥50% reductions in LDLC on risk of developing the first cardiovascular events. Among rosuvastatin allocated participants, 3640 individuals (46.3%) experienced an LDLC reduction ≥50%; 3365 individuals (42.8%) experienced an LDLC reduction >0 but <50%; and 851 individuals (10.8%) experienced no reduction or an increase in LDLC compared with baseline. These % LDLC reductions directly related to the risks of first cardiovascular events; at trial completion, incidence rates for the primary endpoint were 11.2, 9.2, 6.7, and 4.8 per 1000 person-years for those in the placebo, no LDLC reduction, LDLC reduction <50%, and LDLC reduction ≥50% groups, respectively. Compared with placebo, the multivariable adjusted hazard ratios for sequentially greater on-treatment per cent reductions in LDLC were 0.91 (95%CI 0.54-1.53), 0.61 (95%CI 0.44-0.83), and 0.43 (95%CI 0.30-0.60) (P < 0.00001). Similar relationships between % reduction and clinical outcomes were observed in analyses focusing on non-HDLC or apolipoprotein B. CONCLUSIONS: As documented for low- and moderate-intensity regimens, variability in % LDLC reduction following high-intensity statin therapy is wide yet the magnitude of this % reduction directly relates to efficacy. These data support guideline approaches that incorporate % reduction targets for statin therapy as well as absolute targets, and might provide a structure for the allocation of emerging adjunctive lipid-lowering therapies such as PCSK9 inhibitors should these agents prove broadly effective for cardiovascular event reduction."}