{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:33:29Z","timestamp":1792802009965,"version":"4.5.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T00:00:00Z","timestamp":1706227200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T00:00:00Z","timestamp":1706227200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100019944","name":"Sanofi-Aventis Deutschland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019944","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neth Heart J"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>Low-density lipoprotein cholesterol (LDL-C) lowering constitutes a\u00a0cornerstone of secondary prevention of atherosclerotic cardiovascular disease (ASCVD), yet a\u00a0considerable number of patients do not achieve guideline-recommended LDL\u2011C targets. The 2016 European guidelines recommended titration of LDL\u2011C lowering medication in a\u00a0set number of steps, starting with oral medication. We aimed to investigate the effects of this stepwise approach in post-acute coronary syndrome (ACS) patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In a\u00a0multicentre, prospective, non-randomised trial, we evaluated a\u00a0three-step strategy aiming to reduce LDL\u2011C to \u2264\u202f1.8\u202fmmol\/l in post-ACS patients with prior ASCVD and\/or diabetes mellitus. Steps, undertaken every 4\u20136\u00a0weeks, included: 1)\u00a0start high-intensity statin (HIST); 2)\u00a0addition of ezetimibe; 3)\u00a0addition of proprotein convertase subtilisin\/kexin type\u00a09 inhibitors (PCSK9i). The primary outcome was the proportion of patients achieving LDL-C\u202f\u2264\u20091.8\u202fmmol\/l after Steps\u00a01 and\u00a02 (using oral medications alone). Secondary outcomes examined the prevalence of meeting the target throughout all steps (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/onderzoekmetmensen.nl\/nl\/trial\/21157\">https:\/\/onderzoekmetmensen.nl\/nl\/trial\/21157<\/jats:ext-link>).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Out of 999 patients, 84% (95% confidence intervals (CI): 81\u201386) achieved the LDL\u2011C target using only statin and\/or ezetimibe. In an intention-to-treat analysis, the percentages of patients meeting the LDL\u2011C target after each step were 69% (95% CI: 67\u201372), 84% (95% CI: 81\u201386), and 87% (95% CI: 85\u201389), respectively. There were protocol deviations for 23,\u00a038 and 23\u00a0patients at each respective step.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Through stepwise intensification of lipid-lowering therapy, 84% of very high-risk post-ACS patients achieved an LDL\u2011C target of \u2264\u202f1.8\u202fmmol\/l with oral medications alone. Addition of PCSK9i further increased this rate to 87% (95% CI: 85\u201389).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12471-023-01851-7","type":"journal-article","created":{"date-parts":[[2024,1,26]],"date-time":"2024-01-26T07:02:07Z","timestamp":1706252527000},"page":"206-212","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Effects of a\u00a0stepwise, structured LDL-C lowering strategy in patients post-acute coronary syndrome"],"prefix":"10.1007","volume":"32","author":[{"given":"Aaram","family":"Omar Khader","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tinka","family":"van Trier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander","family":"van der Brug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"An-ho","family":"Liem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bjorn E.","family":"Groenemeijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Schut","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald T.","family":"Jorstad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice M.A.C.","family":"Martens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco A.M.W.","family":"Alings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,26]]},"reference":[{"key":"1851_CR1","doi-asserted-by":"publisher","first-page":"1350","DOI":"10.1001\/jama.2010.1322","volume":"304","author":"DL Bhatt","year":"2010","unstructured":"Bhatt\u00a0DL, Eagle\u00a0KA, Ohman\u00a0EM, et\u00a0al. 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H.T.\u00a0Jorstad: Editor for NEHJ. F.M.A.C.\u00a0Martens: co-author of the Dutch cardiovascular risk management guidelines (CVRM). A.M.W.\u00a0Alings: consulting fees from Sanofi. A.\u00a0Omar Khader, T.\u00a0van Trier, S.\u00a0van der Brug, B.E.\u00a0Groenemeijer and A.\u00a0Schut declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The trial was reviewed and approved by the Institutional Review Board, i.e. the ethics committee (Medical Research Ethics Committees United (MEC-U)\u201466879.100.18_R18.063). All patients signed written informed consent at inclusion.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}