{"id":"ee79430f2baa","type":"article","url":"https://hartvaat.nl/2025/02/01/alternatieve-ldl-verlagingsstrategie-versus-hoge-dosis-statine-bij-ascvd-meta-an/","title":"Alternatieve LDL-verlagingsstrategie versus hoge-dosis statine bij ASCVD: meta-analyse","title_en":"Alternative LDL Cholesterol-Lowering Strategy vs High-Intensity Statins in Atherosclerotic Cardiovascular Disease: A Systematic Review and Individual Patient Data Meta-Analysis.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","figaro-dkd","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","statines"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2024.3911","source_url":"https://doi.org/10.1001/jamacardio.2024.3911","authors":["Yong-Joon Lee","Bum-Kee Hong","Kyeong Ho Yun","Woong Chol Kang","Soon Jun Hong","Sang-Hyup Lee","Seung-Jun Lee","Sung-Jin Hong","Chul-Min Ahn","Jung-Sun Kim","Byeong-Keuk Kim","Young-Guk Ko","Donghoon Choi","Yangsoo Jang","Myeong-Ki Hong"],"significance":7,"published":"2025-02-01","source_date":"2025-02-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This meta-analysis showed that alternative LDL-lowering strategies (moderate statin plus ezetimibe or PCSK9 inhibitor) achieve comparable cardiovascular outcomes to high-intensity statin monotherapy in ASCVD patients, supporting personalized lipid-lowering approaches.","created":"2026-07-03T10:31:28Z","updated":"2026-07-03T13:30:29Z","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":"Meta-analyse vergeleek alternatieve LDL-verlagingsstrategieën (matige statine + ezetimibe of PCSK9-remmer) met hoge-dosis statine bij ASCVD. De alternatieve strategie bereikte vergelijkbare LDL-waarden met minder bijwerkingen.","abstract_original":"IMPORTANCE: In patients with atherosclerotic cardiovascular disease (ASCVD), intensive lowering of low-density lipoprotein (LDL) cholesterol levels with high-intensity statins is generally recommended. However, alternative approaches considering statin-related adverse effects and intolerance are needed. OBJECTIVE: To compare the long-term efficacy and safety of an alternative LDL cholesterol-lowering strategy vs high-intensity statin strategy in patients with ASCVD in randomized clinical trials. DATA SOURCES: PubMed, Embase, and other websites (ClinicalTrials.gov, European Society of Cardiology, tctMD) were systematically searched from inception to April 19, 2024. STUDY SELECTION: Randomized clinical trials comparing an alternative LDL cholesterol-lowering strategy vs a high-intensity statin strategy in patients with ASCVD, with presence of cardiovascular events as end points. DATA EXTRACTION AND SYNTHESIS: Individual patient data were obtained from randomized clinical trials that met the prespecified eligibility criteria: RACING (Randomized Comparison of Efficacy and Safety of Lipid-Lowering With Statin Monotherapy vs Statin/Ezetimibe Combination for High-Risk Cardiovascular Disease) and LODESTAR (Low-Density Lipoprotein Cholesterol-Targeting Statin Therapy vs Intensity-Based Statin Therapy in Patients With Coronary Artery Disease). The moderate-intensity statin with ezetimibe combination therapy in the RACING trial and the treat-to-target strategy in the LODESTAR trial were classified as alternative LDL cholesterol-lowering strategies. The primary analysis was based on a 1-stage approach. MAIN OUTCOMES AND MEASURES: The primary end point was a 3-year composite of all-cause death, myocardial infarction, stroke, or coronary revascularization. The secondary end points comprised clinical efficacy and safety end points. RESULTS: Individual patient data from 2 trials including 8180 patients with ASCVD (mean [SD] age, 64.5 [9.8] years; 2182 [26.7%] female; 5998 male [73.3%]) were analyzed. The rate of the primary end point did not differ between the alternative strategy and high-intensity statin strategy groups (7.5% [304 of 4094] vs 7.7% [310 of 4086]; hazard ratio, 0.98; 95% CI, 0.84-1.15; P = .82). The mean (SD) LDL cholesterol level during treatment was 64.8 (19.0) mg/dL in the alternative strategy group and 68.5 (20.7) mg/dL in the high-intensity statin strategy group (P < .001). The alternative strategy group had a lower rate of new-onset diabetes (10.2% [271 of 2658] vs 11.9% [316 of 2656]; P = .047), initiation of antidiabetic medication for new-onset diabetes (6.5% [173 of 2658] vs 8.2% [217 of 2656]; P = .02), and intolerance-related discontinuation or dose reduction of assigned therapy (4.0% [163 of 4094] vs 6.7% [273 of 4086]; P < .001). CONCLUSIONS AND RELEVANCE: Results of this systematic review and individual patient data meta-analysis suggest that compared with a high-intensity statin strategy, the alternative LDL cholesterol-lowering strategy demonstrated comparable efficacy regarding 3-year death or cardiovascular events in patients with ASCVD, with an associated reduction in LDL cholesterol levels and risk for new-onset diabetes and intolerance. STUDY REGISTRATION: PROSPERO CRD42024532550."}