From intensive statins to intensive lipid lowering: Amplitude of low-density lipoprotein-cholesterol lowering is the core for atherosclerosis cardiovascular disease prevention

Cholesterol is a risk factor for atherosclerotic cardiovascular disease (ASCVD). The epidemiology, clinical intervention trials, and genetic studies that low-density lipoproteins (LDLs) cause ASCVD. Lowering LDL-C is a cornerstone and important strategy for the prevention and treatment of ASCVD. The benefit of reducing ASCVD by statins is completely dependent on the absolute reduction of LDL-C. Several recent large trials have also now shown that lowering LDL with non-statins reduces cardiovascular events. In ASCVD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions in CV events in the IMPROVE IT, FOURIER, and the ODYSSEY-OUTCOMES trials. Compared with high-dose statins, statins combined with nonstatins, such as ezetimibe, can more effectively lower LDL-C and can result in a more significant reduction in the risk of CVD. Therefore, this therapy is a lipid-lowering option with significant efficacy and sufficient evidence of benefit in clinical practice