4. Discussion
ASCVD
ADVERSE EVENT, EVENTS, ADVERSE EFFECTS, ATHEROSCLEROTIC CARDIOVASCULAR DISEASE, HEART, ASCVD
The principal finding of this study is that treatment with low-intensity A5 plus E significantly lowered LDL cholesterol levels by 49.2% over 8 weeks compared with moderate-intensity A10 (36.4%). This difference was accompanied by a higher rate of LDL cholesterol goal achievement (93.3% of patients with low and intermediate risks and 54.6% of those with high and very high risks). The results also showed that A5E had favorable effects on total cholesterol, non-HDL cholesterol, and apolipoprotein B. Adverse events were infrequent and did not differ across the groups. These findings suggest that the strategy of using a fixed-dose combination therapy of low-intensity A5E may be more suited for patients with low and intermediate risks. However, this strategy achieved the LDL cholesterol goal of < Current guidelines emphasize the importance of reducing LDL cholesterol levels in patients with atherosclerotic cardiovascular disease (ASCVD) as well as in apparently healthy people. The 2018 American College of Cardiology/American Heart Association guideline recommends high intensity statin for adjunctive lipid-lowering therapy in patients with high and very high risks, and moderate-intensity statin in those with low and intermediate risks.Numerous studies have established the key role of statins in cardiovascular risk reduction in patients with ASCVD, and recommended the intensification of LDL cholesterol-lowering therapy according to their baseline risk. However, statin-related adverse effects are usually dose-dependent, and some patients are intolerant to moderate-intensity statins.This study has several limitations. First, it was conducted on a small number of patients using surrogate endpoints. There remains uncertainty as to the utility of this approach in reducing clinical events, requiring cardiovascular outcome trials. Second, our approach may not be generalizable to patients with high and very high risks because it had only moderate potency in reducing LDL cholesterol.