{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:53:35Z","timestamp":1790178815722,"version":"4.1.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2021,3,16]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Recent international guidelines have lowered recommended target levels of low-density lipoprotein cholesterol (LDL-C) for patients at very high risk for major adverse cardiovascular events (MACE). However, uncertainty persists whether additional benefit results from achieved LDL-C levels below the conventional targets. Inferences from previous analyses are limited because patients who achieve lower versus higher LDL-C on lipid-lowering therapy differ in other characteristics prognostic for MACE and because few achieved very low LDL-C levels. To overcome these limitations, we performed a propensity score\u2013matching analysis of the ODYSSEY OUTCOMES trial (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) which compared alirocumab with placebo in 18\u2009924 patients with recent acute coronary syndrome receiving intensive or maximum-tolerated statin treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Patients on alirocumab were classified in prespecified strata of LDL-C achieved at 4 months of treatment: &lt;25 (n=3357), 25 to 50 (n=3692), or &gt;50 mg\/dL (n=2197). For each stratum, MACE (coronary heart disease death, nonfatal myocardial infarction, ischemic stroke, or hospitalization for unstable angina) after month 4 was compared in patients receiving placebo with similar baseline characteristics and adherence by using 1:1 propensity score matching.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Across achieved LDL-C strata of the alirocumab group, patients differed by baseline LDL-C, lipoprotein(a), use of intensive statin therapy, study medication adherence, and other demographic, medical history, biometric, and laboratory criteria. After propensity score matching, characteristics were similar in corresponding patients of the alirocumab and placebo groups. Treatment hazard ratio, 95% CI, and absolute risk reduction (number per 100 patient-years) for MACE were similar in those with achieved LDL-C &lt;25 mg\/dL (hazard ratio, 0.74 [95% CI, 0.62\u20130.89]; absolute risk reduction, 0.92) or 25 to 50 mg\/dL (hazard ratio, 0.74 [95% CI, 0.64\u20130.87]; absolute risk reduction, 1.05). Patients with achieved LDL-C &gt;50 mg\/dL had poorer adherence and derived less benefit (hazard ratio, 0.87 [95% CI, 0.73\u20131.04]; absolute risk reduction, 0.62). No safety concerns were associated with a limited period of LDL-C levels &lt;15 mg\/dL.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>After accounting for differences in baseline characteristics and adherence, patients treated with alirocumab who achieved LDL-C levels &lt;25 mg\/dL had a reduction in the risk of MACE that was similar to that of patients who achieved LDL-C levels of 25 to 50 mg\/dL.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01663402.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.120.049447","type":"journal-article","created":{"date-parts":[[2021,1,13]],"date-time":"2021-01-13T11:04:35Z","timestamp":1610535875000},"page":"1109-1122","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":82,"title":["Clinical Efficacy and Safety of Alirocumab After Acute Coronary Syndrome According to Achieved Level of Low-Density Lipoprotein Cholesterol"],"prefix":"10.1161","volume":"143","clinical-trial-number":[{"clinical-trial-number":"nct01663402","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2954-0695","authenticated-orcid":true,"given":"Gregory G.","family":"Schwartz","sequence":"first","affiliation":[{"name":"Division of Cardiology, School of Medicine, University of Colorado, Aurora (G.G.S., M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6896-2941","authenticated-orcid":true,"given":"Philippe","family":"Gabriel Steg","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris, Assistance Publique-H\u00f4pitaux de Paris, H\u00f4pital Bichat, INSERM U1148, France (P.G.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-6245","authenticated-orcid":true,"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart &amp; Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-850X","authenticated-orcid":true,"given":"Vera A.","family":"Bittner","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Disease, University of Alabama at Birmingham (V.A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2181-9579","authenticated-orcid":true,"given":"Rafael","family":"Diaz","sequence":"additional","affiliation":[{"name":"Estudios Cardiol\u00f3gicos Latinoam\u00e9rica, Instituto Cardiovascular de Rosario, Argentina (R.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8068-2440","authenticated-orcid":true,"given":"Shaun G.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre, University of Alberta, Edmonton, and St. Michael\u2019s Hospital, University of Toronto, Ontario, Canada (S.G.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3246-8359","authenticated-orcid":true,"given":"J. Wouter","family":"Jukema","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Leiden University Medical Center, The Netherlands (J.W.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Un","family":"Kim","sequence":"additional","affiliation":[{"name":"Sanofi, Paris, France (Y.-U.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian H.","family":"Li","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc, Tarrytown, NY (Q.H.L., G.M., R.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garen","family":"Manvelian","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc, Tarrytown, NY (Q.H.L., G.M., R.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8001-6795","authenticated-orcid":true,"given":"Robert","family":"Pordy","sequence":"additional","affiliation":[{"name":"Regeneron Pharmaceuticals Inc, Tarrytown, NY (Q.H.L., G.M., R.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timoth\u00e9e","family":"Sourdille","sequence":"additional","affiliation":[{"name":"Sanofi, Bridgewater, NJ (T.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7712-6750","authenticated-orcid":true,"given":"Harvey D.","family":"White","sequence":"additional","affiliation":[{"name":"Green Lane Cardiovascular Services, Auckland City Hospital, New Zealand (H.D.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Szarek","sequence":"additional","affiliation":[{"name":"Division of Cardiology, School of Medicine, University of Colorado, Aurora (G.G.S., M.S.)."},{"name":"CPC Clinical Research, University of Colorado School of Medicine, Aurora (M.S.)."},{"name":"State University of New York, Downstate School of Public Health, Brooklyn (M.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"For the 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Propensity Score\u2013Matched Analysis of the ODYSSEY OUTCOMES Trial"],"short-title":[],"issued":{"date-parts":[[2021,3,16]]},"references-count":23,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2021,3,16]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.120.049447"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.120.049447","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,16]]},"assertion":[{"value":"2020-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-12-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-01-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}