{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T02:51:07Z","timestamp":1788576667593,"version":"build-2803163510"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T00:00:00Z","timestamp":1749686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Scientific Research Fund of Xinxiang Medical University","award":["XYBSKYZZ201609"],"award-info":[{"award-number":["XYBSKYZZ201609"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Reducing elevated low-density lipoprotein cholesterol (LDL-C) is central to global efforts to prevent myocardial infarction (MI). While many studies have evaluated LDL-C-lowering therapies in first-time and recurrent MI prevention, direct comparisons of their relative efficacy are lacking. Therefore, we conducted a systematic review and meta-analysis to compare the efficacy of LDL-C-lowering therapies in first-time vs. recurrent MI prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We searched three databases until 30 November 2024, for randomized controlled trials (RCTs) with at least 1000 patient-years of follow-up. Efficacy was quantified as relative risk (RR) with 95% confidence intervals (CIs). Differences in benefit magnitude were assessed using Cochran\u2019s Q test. Data were pooled with a random-effects model, and heterogeneity was measured using the I2 statistic. Additionally, we applied the Cochrane Risk of Bias Tool to evaluate study quality and utilized the GRADE method to assess the certainty of the evidence. This study included 22 large-scale RCTs involving 180 304 participants. In first-time MI prevention, LDL-C-lowering therapies achieved a remarkable 38% reduction in MI risk [12 RCTs; 79 604 participants; RR, 0.62 (95% CI, 0.55\u20130.69); P &amp;lt; 0.001]. In recurrent MI prevention, these therapies were associated with a more modest but significant 16% risk reduction [11 RCTs; 100 700 participants; RR, 0.84 (95% CI, 0.80\u20130.88); P &amp;lt; 0.001]. Importantly, the benefit magnitude between the two groups was significantly different (Q = 22.63; P &amp;lt; 0.001), highlighting the greater relative benefit in first-time MI prevention. Furthermore, the robustness of our findings was consistently supported by leave-one-out analyses, the absence of publication bias, high-quality GRADE evidence, and subgroup and sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that LDL-C-lowering therapies may offer a greater benefit in preventing first-time MI compared with recurrent MI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf336","type":"journal-article","created":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T07:50:35Z","timestamp":1749714635000},"page":"2033-2044","source":"Crossref","is-referenced-by-count":1,"title":["Comparative efficacy of LDL-C-lowering therapies in first-time vs. recurrent myocardial infarction prevention: a meta-analysis of large-scale randomized controlled trials"],"prefix":"10.1093","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-809X","authenticated-orcid":false,"given":"Bao-Qiang","family":"Guo","sequence":"first","affiliation":[{"name":"School of Public Health, Xinxiang Medical University , 601 Jinsui Road, Xinxiang, Henan 453003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Bin","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Health, Xinxiang Medical University , 601 Jinsui Road, Xinxiang, Henan 453003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zhao","sequence":"additional","affiliation":[{"name":"Zhumadian Central Hospital, Affiliated Hospital of Huanghuai University , Zhumadian, Henan 463000 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng-Wei","family":"Xu","sequence":"additional","affiliation":[{"name":"School of Public Health, Xinxiang Medical University , 601 Jinsui Road, Xinxiang, Henan 453003 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,12]]},"reference":[{"key":"2026090410571583900_zwaf336-B1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026090410571583900_zwaf336-B2","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1001\/jama.2016.13985","article-title":"Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis","volume":"316","author":"Silverman","year":"2016","journal-title":"JAMA"},{"key":"2026090410571583900_zwaf336-B3","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1016\/S0140-6736(03)12948-0","article-title":"Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial\u2013Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial","volume":"361","author":"Sever","year":"2003","journal-title":"Lancet"},{"key":"2026090410571583900_zwaf336-B4","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0140-6736(06)69472-5","article-title":"Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA study): a prospective randomised controlled trial","volume":"368","author":"Nakamura","year":"2006","journal-title":"Lancet"},{"key":"2026090410571583900_zwaf336-B5","doi-asserted-by":"crossref","first-page":"2195","DOI":"10.1056\/NEJMoa0807646","article-title":"Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein","volume":"359","author":"Ridker","year":"2008","journal-title":"N Engl J Med"},{"key":"2026090410571583900_zwaf336-B6","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1056\/NEJM199610033351401","article-title":"Cholesterol and Recurrent Events Trial investigators. 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