Authors:
Dawn Fuke, BS Pharm, PharmD, BCPS
Catherine Behret, PharmD, BCACP
Reviewers:
Dave Dixon, PharmD, BCACP, CDCES, CLS
Michael Kelly, PharmD, BCACP, CDCES, CLS
Citation:
Hong SJ, Lee YJ, Lee SJ, et al. Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease: A Randomized Clinical Trial. JAMA. 2023;329(13):1078-1087.
The Problem
Is there a “best” strategy for statin use in patients with atherosclerotic cardiovascular disease (ASCVD)? There has been a long-standing debate about the optimal approach to statin use, including whether we should initiate therapy using a “fixed-dose” high-potency statin or whether we should “start low and go slow” by titrating the dose to a specific LDL-C target. The LODESTAR study was designed to determine if treating LDL-C to a target level produces similar cardiovascular outcomes when compared to a fixed-dose approach.1
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I think you all came to the correct conclusion based on the data. This study is not a slam dunk for treat-to-target aficionados.