TREAT-TO-TARGET VERSUS OTHER APPROACHES OF STATIN THERAPY IN ATHEROSCLEROTIC CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of disability and mortality globally. A key strategy to prevent recurrent major adverse cardiovascular events (MACE), through reducing low-density lipoprotein cholesterol (LDL-C) levels, in ASCVD patients is lipid-lowering therapy, with high-intensity statins as the standard approach. However, their use carries potential risks of adverse effects. Treat-to-target statin therapy (TTT), an approach that titrates statin dosage based on the patient’s response to achieve a specific LDL-C target, might be an alternative. This systematic review and meta-analysis aimed to compare the efficacy of TTT, fixed-dose high-intensity statin therapy (FH), and no-initial-statin therapy on MACE and LDL-C level in patients with ASCVD. PubMed and Scopus were searched through January 26, 2024, to identify randomized clinical trials (RCTs) evaluating TTT in patients with ASCVD. Two RCTs comparing TTT with target LDL-C of 80-110 mg/dL (TTT110) to no-initial-statin therapy showed a statistically non-significant reduction in risk for MACE (risk ratio [RR] 0.66, 95% confidence interval [CI]: 0.37, 1.16). TTT with target LDL-C of 70 mg/dL (TTT70) resulted in significantly lower risk of MACE than TTT110 (RR 0.86, 95% CI: 0.76, 0.96) in two RCTs. In contrast, the comparison between TTT70 and FH from one RCT suggested no significant difference in the risk of MACE (RR 0.93, 95% CI: 0.77, 1.13). In conclusion, TTT70 appeared to have similar efficacy to FH as an ASCVD secondary prevention strategy.
Downloads
Published
Issue
Section
License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.