Two LDL-cholesterol lowering strategy: comparison of the efficacy of the treat-to-target and the percent LDL-C reduction in the everyday clinical practice – ATTENTION Trial
MH EK Honvédkórház, II. sz.Belgyógyászati Osztály, Budapest
The 2013 ACC/AHA guidelines fundamentally reformed our LDL-cholesterol-lowering (LDL-C) strategies. The data from the evidence based trials suggest that the previous treat-to-target recommendations (2.6 and 1.8 mmol/L) are controversial. Only the percent LDL-C reduction is an objective measure, the new guidelines established the basis of this new concept. As a conclusion in the high cardiovascular risk group moderate intensity (30-50%) and in the very high risk group high intensity (> 50%) LDL-C reduction is the therapeutic target. In 2016 the ESC/EAS adopted this approach as an alternative option.
In our study we evaluated the efficacy of the two theratpeutic approach in the everyday clinical practice. 5652 patients with hypercholesterolemia participated, 4302 patients were treated in the treat-to-target group, and 1350 patients in the percent LDL-C group. During the 12 month of the study patients attended in 3 evaluation.
The percent LDL-C reduction strategy was apparently more successful, higher proportion of the patients reached the therapeutic target in the statin naive high cardiovascular risk group, compared to the treat-to-target group. Higher LDL-C levels are accompanied by higher 30-50% LDL-C reduction absolute value, we can reach it easier. The statin naïve patient had a higher baseline LDL-C level compared to the statin pre-treated patients, which can be an explanation of the success of the percent LDL-C reduction strategy.
According to these results, the percent LDL-C reduction strategy should be preferred in the high risk, statin naïve patient group, and the ESC/EAS recommended 50% reduction should be reached, which can induce plaque regression.