The same reasoning holds for any patient whose LDL-C level remains 70 mg/dL ( 1.8 mmol/L) on maximally tolerated statin therapy 10. The CORONA (Controlled Rosuvastatin Multi national Trial in Heart Failure) trialS4.1-38 (patients with ischemic HF and left ventricular ejection fraction <40%) and GISSI HF trial (Effects of n-3 PUFA and Rosuvastatin on Mortality-Morbidity of Patients With Symptomatic CHF)S4.1-39 (patients with ischemic and nonischemic HF, 9.8% with left ventricular ejection fraction >40%) evaluated the efficacy and safety of initiation of 10 mg of rosuv- astatin daily compared with placebo. Neither trial met its primary outcome. Rosuvastatin reduced the risk of total hospitalizations, hospitalizations for a cardiovascular cause, and hospitalizations for worsening HF in CORONA. A subsequent analysis accounting for repeat HF hospitalizations showed significant reduction in HF hospitalizations.S4.1-46 Post hoc analyses from CORONA showed that patients randomized to rosuvastatin with less advanced HF with reduced ejection fraction (low- est tertile of NT-proBNP) had a significant reduction in the primary outcome, but no benefit was seen among patients with more advanced HF.S4.1-47 The CORONA and GISSI studies were notable for high overall and cardiovascular mortality rates, with MI occurring in a small minority. A subsequent that pooled data from both these trials and accounted for competing causes of death showed a significant 19% reduc- tion in the risk of MI with rosuvastatin in patients with ischemic HF, although the ARR was small. 4.2. Severe Hypercholesterolemia (LDL-C 190 mg/dL [ 4.9 mmol/L]) Recommendations for Primary Severe Hypercholesterolemia (LDL-C 190 mg/dL [ 4.9 mmol/L]) Referenced studies that support recommendations are summarized in Online Data Supplements 9 and 10. 