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

DC Field Value Language
dc.contributor.author고영국-
dc.contributor.author김병극-
dc.contributor.author김중선-
dc.contributor.author안철민-
dc.contributor.author이승준-
dc.contributor.author이용준-
dc.contributor.author최동훈-
dc.contributor.author홍명기-
dc.contributor.author홍범기-
dc.contributor.author홍성진-
dc.date.accessioned2023-05-31T05:20:55Z-
dc.date.available2023-05-31T05:20:55Z-
dc.date.issued2023-04-
dc.identifier.issn0098-7484-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/194174-
dc.description.abstractIMPORTANCE 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.-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherAmerican Medical Association-
dc.relation.isPartOfJAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.subject.MESHAged-
dc.subject.MESHAtorvastatin* / administration & dosage-
dc.subject.MESHAtorvastatin* / adverse effects-
dc.subject.MESHAtorvastatin* / therapeutic use-
dc.subject.MESHCholesterol, LDL* / blood-
dc.subject.MESHCoronary Artery Disease* / blood-
dc.subject.MESHCoronary Artery Disease* / complications-
dc.subject.MESHCoronary Artery Disease* / drug therapy-
dc.subject.MESHFemale-
dc.subject.MESHHumans-
dc.subject.MESHHydroxymethylglutaryl-CoA Reductase Inhibitors* / administration & dosage-
dc.subject.MESHHydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects-
dc.subject.MESHHydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use-
dc.subject.MESHHyperlipoproteinemias* / blood-
dc.subject.MESHHyperlipoproteinemias* / complications-
dc.subject.MESHHyperlipoproteinemias* / drug therapy-
dc.subject.MESHMale-
dc.subject.MESHMiddle Aged-
dc.subject.MESHMyocardial Infarction / etiology-
dc.subject.MESHRosuvastatin Calcium* / administration & dosage-
dc.subject.MESHRosuvastatin Calcium* / adverse effects-
dc.subject.MESHRosuvastatin Calcium* / therapeutic use-
dc.subject.MESHStroke / etiology-
dc.subject.MESHTreatment Outcome-
dc.titleTreat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Internal Medicine (내과학교실)-
dc.contributor.googleauthorSung-Jin Hong-
dc.contributor.googleauthorYong-Joon Lee-
dc.contributor.googleauthorSeung-Jun Lee-
dc.contributor.googleauthorBum-Kee Hong-
dc.contributor.googleauthorWoong Chol Kang-
dc.contributor.googleauthorJong-Young Lee-
dc.contributor.googleauthorJin-Bae Lee-
dc.contributor.googleauthorTae-Hyun Yang-
dc.contributor.googleauthorJunghan Yoon-
dc.contributor.googleauthorChul-Min Ahn-
dc.contributor.googleauthorJung-Sun Kim-
dc.contributor.googleauthorByeong-Keuk Kim-
dc.contributor.googleauthorYoung-Guk Ko-
dc.contributor.googleauthorDonghoon Choi-
dc.contributor.googleauthorYangsoo Jang-
dc.contributor.googleauthorMyeong-Ki Hong-
dc.identifier.doi10.1001/jama.2023.2487-
dc.contributor.localIdA00127-
dc.contributor.localIdA00493-
dc.contributor.localIdA00961-
dc.contributor.localIdA02269-
dc.contributor.localIdA02927-
dc.contributor.localIdA02984-
dc.contributor.localIdA04053-
dc.contributor.localIdA04391-
dc.contributor.localIdA04394-
dc.contributor.localIdA04403-
dc.relation.journalcodeJ01196-
dc.identifier.eissn1538-3598-
dc.identifier.pmid36877807-
dc.identifier.urlhttps://jamanetwork.com/journals/jama/fullarticle/2802214-
dc.contributor.alternativeNameKo, Young Guk-
dc.contributor.affiliatedAuthor고영국-
dc.contributor.affiliatedAuthor김병극-
dc.contributor.affiliatedAuthor김중선-
dc.contributor.affiliatedAuthor안철민-
dc.contributor.affiliatedAuthor이승준-
dc.contributor.affiliatedAuthor이용준-
dc.contributor.affiliatedAuthor최동훈-
dc.contributor.affiliatedAuthor홍명기-
dc.contributor.affiliatedAuthor홍범기-
dc.contributor.affiliatedAuthor홍성진-
dc.citation.volume329-
dc.citation.number13-
dc.citation.startPage1078-
dc.citation.endPage1087-
dc.identifier.bibliographicCitationJAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol.329(13) : 1078-1087, 2023-04-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

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