{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T16:53:18Z","timestamp":1790959998630,"version":"4.1.0"},"reference-count":25,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2023,4,4]]},"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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\u2009=\u20092200), 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\u2009=\u20092200) (\n P<\/jats:italic>\n \u2009=\u2009.21, 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, \u20130.6 percentage points [upper boundary of the 1-sided 97.5% CI, 1.1 percentage points];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001 for noninferiority).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02579499<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2023.2487","type":"journal-article","created":{"date-parts":[[2023,3,6]],"date-time":"2023-03-06T14:00:26Z","timestamp":1678111226000},"page":"1078","source":"Crossref","is-referenced-by-count":112,"title":["Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease"],"prefix":"10.1001","volume":"329","author":[{"given":"Sung-Jin","family":"Hong","sequence":"first","affiliation":[{"name":"Severance Hospital, Yonsei University College of Medicine, Seoul, South 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