Escalation of liPid-lOwering therapy in patientS wiTh vascular disease receiving HIGH-intensity statins: the retrospective POST-HIGH study

In this retrospective study, we investigated whether lipid-lowering therapy (LLT) escalation has clinical benefits in patients with atherosclerotic cardiovascular disease (ASCVD) and low-density lipoprotein cholesterol (LDL-C) levels of 55-99 mg/dL (1.4-2.6 mmol/L), post high-intensity. Out of 6317 Korean patients screened in 2005-2018, 1159 individuals with ASCVD and LDL-C levels of 55-99 mg/dL after statin use equivalent to 40 mg atorvastatin were included. After 1:2 propensity score matching, 492 patients (164 with LLT escalation, 328 controls without LLT escalation) were finally analysed. Primary outcome variables were major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death. At median follow-up (1.93 years), the escalation group had a lower MACCE rate (1.72 vs. 3.38 events/100 person-years; hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.14-0.83; p = 0.018) than the control group. The incidence of all-cause death (0.86 vs. 1.02 events/100 person-years; HR 0.58, 95% CI 0.15-2.19; p = 0.42) and each MACCE component did not differ between groups. Kaplan-Meier curves exhibited lower risk of MACCE in the escalation group (HR 0.36, 95% CI 0.12-0.97; p = 0.040) but a difference not statistically significant in all-cause death (HR 0.30, 95% CI 0.04-2.48; p = 0.26). LLT escalation was associated with reduced cardiovascular risk, supporting more aggressive LLT in this population.