# LODESTAR: treat-to-target versus hoge-dosis statine bij coronairlijden

*geplaatst 2023-04-04 · Cholesterol · JAMA · doi 10.1001/jama.2023.2487 · https://hartvaat.nl/2023/04/04/lodestar-treat-to-target-versus-hoge-dosis-statine-bij-coronairlijden/*

De LODESTAR-trial in JAMA toonde dat een treat-to-target benadering (LDL <70 mg/dL) non-inferieur was aan standaard hoge-dosis statine bij coronairlijden. Treat-to-target bereikt vergelijkbare uitkomsten met minder bijwerkingen door dosisaanpassing op geleide van het LDL.

## English: Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial.

The LODESTAR trial showed that a treat-to-target approach (targeting LDL <70 mg/dL with dose adjustment) was noninferior to fixed high-intensity statin therapy for cardiovascular outcomes in patients with coronary artery disease. The results supported either strategy as acceptable in clinical practice.

## Abstract (original, from the publication)

IMPORTANCE: In patients with coronary artery disease, some guidelines recommend initial statin treatment with high-intensity statins to achieve at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C). An alternative approach is to begin with moderate-intensity statins and titrate to a specific LDL-C goal. These alternatives have not been compared head-to-head in a clinical trial involving patients with known coronary artery disease. OBJECTIVE: To assess whether a treat-to-target strategy is noninferior to a strategy of high-intensity statins for long-term clinical outcomes in patients with coronary artery disease. DESIGN, SETTING, AND PARTICIPANTS: A randomized, multicenter, noninferiority trial in patients with a coronary disease diagnosis treated at 12 centers in South Korea (enrollment: September 9, 2016, through November 27, 2019; final follow-up: October 26, 2022). INTERVENTIONS: Patients were randomly assigned to receive either the LDL-C target strategy, with an LDL-C level between 50 and 70 mg/dL as the target, or high-intensity statin treatment, which consisted of rosuvastatin, 20 mg, or atorvastatin, 40 mg. MAIN OUTCOMES AND MEASURES: Primary end point was a 3-year composite of death, myocardial infarction, stroke, or coronary revascularization with a noninferiority margin of 3.0 percentage points. RESULTS: Among 4400 patients, 4341 patients (98.7%) completed the trial (mean [SD] age, 65.1 [9.9] years; 1228 females [27.9%]). In the treat-to-target group (n = 2200), which had 6449 person-years of follow-up, moderate-intensity and high-intensity dosing were used in 43% and 54%, respectively. The mean (SD) LDL-C level for 3 years was 69.1 (17.8) mg/dL in the treat-to-target group and 68.4 (20.1) mg/dL in the high-intensity statin group (n = 2200) (P = .21, compared with the treat-to-target group). The primary end point occurred in 177 patients (8.1%) in the treat-to-target group and 190 patients (8.7%) in the high-intensity statin group (absolute difference, -0.6 percentage points [upper boundary of the 1-sided 97.5% CI, 1.1 percentage points]; P < .001 for noninferiority). CONCLUSIONS AND RELEVANCE: Among patients with coronary artery disease, a treat-to-target LDL-C strategy of 50 to 70 mg/dL as the goal was noninferior to a high-intensity statin therapy for the 3-year composite of death, myocardial infarction, stroke, or coronary revascularization. These findings provide additional evidence supporting the suitability of a treat-to-target strategy that may allow a tailored approach with consideration for individual variability in drug response to statin therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02579499.

Auteurs: Sung-Jin Hong, Yong-Joon Lee, Seung-Jun Lee, Bum-Kee Hong, Woong Chol Kang, Jong-Young Lee, Jin-Bae Lee, Tae-Hyun Yang, Junghan Yoon, Chul-Min Ahn, Jung-Sun Kim, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Yangsoo Jang, Myeong-Ki Hong

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Bron: JAMA, https://doi.org/10.1001/jama.2023.2487. Bijgewerkt 2026-07-03T13:29:23Z. 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.