Very Low LDL Levels Best in Secondary Prevention: Ez-PAVE

Key Points:

• The Ez-PAVE trial involving over 3,000 South Korean patients with atherosclerotic cardiovascular disease (ASCVD) found that lowering LDL cholesterol to below 55 mg/dL significantly reduced the 3-year risk of major cardiovascular events by 33% compared to a target of less than 70 mg/dL.
• Patients targeting LDL <55 mg/dL had lower rates of cardiovascular death, nonfatal myocardial infarction, stroke, revascularization, and hospitalization for unstable angina, with no significant safety concerns identified between the two groups.
• The study supports recent American dyslipidemia guidelines advocating for more intensive LDL lowering in secondary prevention, emphasizing the cost-effectiveness of ezetimibe combined with statins before considering PCSK9 inhibitors.
• Experts noted the results reinforce the message that "55 mg/dL is the new goal" for LDL cholesterol in ASCVD patients, suggesting simplification of risk categories for secondary prevention could aid clinical practice.
• While the trial was conducted in a South Asian population, experts believe the findings are consistent with other lipid-lowering studies and broadly applicable; however, further research is needed to determine implications for primary prevention patients.