Physicians' Academy for Cardiovascular Education

LDL-c goal attainment after STEMI with early combination therapy

Intensive lipid-lowering therapy for early achievement of guideline-recommended LDL-cholesterol levels in patients with ST-elevation myocardial infarction (“Jena auf Ziel”)

Literature - Makhmudova U, Samadifar B, Maloku A, et al. - Clin Res Cardiol. 2023 Jan 5. doi: 10.1007/s00392-022-02147-3

Introduction and methods


The Swedish SWEDEHEART registry recently showed that 17% of patients with a recent MI achieved the LDL-c target recommended in the 2019 ESC/EAS Guidelines for the management of dyslipidaemias (i.e., LDL-c <1.4 mmol/L (<55 mg/dL)), while the remaining 83% would be eligible for expanded lipid-lowering therapy [1]. The 2019 ESC/EAS Guidelines call for high-intensity statin therapy, and if the target is not achieved within 4–6 weeks, add-on therapy with ezetimibe and thereafter a PCSK9i are recommended [2]. Yet, early use of combination lipid-lowering therapy, consisting of a high-intensity statin and ezetimibe, is effective in reducing LDL-c levels [3-7].

Aim of the study

The study aim was to attain the LDL-c target in patients hospitalized for STEMI by treating them with combination lipid-lowering therapy (consisting of atorvastatin 80 mg and ezetimibe 10 mg) as first-line therapy, escalated with either bempedoic acid or a PCSK9i if the target was not reached.


The JaZ (“Jena auf Ziel”) study was a prospective cohort study in 85 patients who were admitted with STEMI to the Jena University Hospital in Jena, Germany from January through December 2021. Upon admission, patients received combination therapy with atorvastatin 80 mg and ezetimibe 10 mg. During the hospital stay, they were educated about CV risk modification. During follow-up, the lipid-lowering therapy was escalated with bempedoic acid or a PCSK9i if needed in order to achieve the recommended LDL-c target in all patients. Patient empowerment was used to increase therapy adherence. The authors also evaluated adverse events of this lipid-lowering strategy.


The primary outcome was achievement of the 2019 ESC/EAS Guidelines–recommended LDL-c target for MI patients (<1.4 mmol/L (<55 mg/dL).

Main results

LDL-c target attainment

Adverse events


In this single-center prospective cohort study, early initiation of combination lipid-lowering therapy with a high-intensity statin (atorvastatin 80 mg) and ezetimibe 10 mg resulted in attainment of the 2019 ESC/EAS Guidelines–recommended LDL-c target at the first follow-up visit in 80% of the patients hospitalized for STEMI. After escalation of therapy with bempedoic acid or a PCSK9i if needed, all patients reached the recommended LDL-c target. The combination lipid-lowering therapy was well tolerated.

The authors point out that in the 2019 ESC/EAS Guidelines, statins alone are first-line lipid-lowering therapy to reduce ASCVD risk and ezetimibe and PCSK9is should be initiated only when the LDL-c target is not met at follow-up. However, when taking the high inter-individual variability in LDL-c reduction into account, amongst others, “early initiation of combined lipid-lowering therapy with a high-intensity statin and ezetimibe appears to be a logical therapeutic strategy.”


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Find this article online at Clin Res Cardiol.

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