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Objective <p>Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of developing atherosclerotic cardiovascular disease (ASCVD). In the PENELOPE study, a&#xa0;guideline-based, protocol-led LDL-C-lowering strategy was applied in patients after myocardial infarction and resulted in 87% reaching target LDL‑C levels of ≤ 1.8 mmol/l within a&#xa0;median of 45&#xa0;days. This study evaluated PENELOPE’s legacy effect on LDL‑C levels after 1&#xa0;year.</p> Methods <p>In the PENELOPE study, 999 patients with a&#xa0;myocardial infarction and a&#xa0;history of ASCVD and/or diabetes mellitus were included. If LDL-C &gt; 1.8 mmol/l, lipid-lowering therapy was intensified in three consecutive steps: (1)&#xa0;high-intensity statin (HIST) monotherapy, (2)&#xa0;HIST + ezetimibe, and (3)&#xa0;HIST + ezetimibe + proprotein convertase subtilisin/kexin type&#xa0;9 inhibitor (PCSK9i). LDL‑C levels were monitored 4–6&#xa0;weeks after each step. The primary objective of this study was to assess the prevalence of the LDL‑C target level of ≤ 1.8 mmol/l being maintained after 1&#xa0;year.</p> Results <p>Data of 738 patients (74%) were available for 1‑year follow-up. The target LDL‑C level was met in 471 patients (64%). Median LDL‑C levels changed from&#xa0;1.5 (1.2–1.7) mmol/l immediately after implementation of the protocol-led strategy to&#xa0;1.6 (1.3–2.0) mmol/l after 1&#xa0;year. Major treatment regimens were statin (58%), statin + ezetimibe (30%) and PCSK9i + ezetimibe (+ statin) (7%).</p> Conclusion <p>After a&#xa0;myocardial infarction, implementation of a&#xa0;protocol-led LDL-C-lowering strategy resulted in 87% of patients attaining the LDL‑C target level of ≤ 1.8 mmol/l within a&#xa0;median of&#xa0;45 (32–77) days. At 1‑year follow-up, 64% maintained this target level and the median LDL‑C increased by 0.1 mmol/l.</p>

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PENELOPE 1-year follow-up: legacy effect of a short protocol-led LDL-C-lowering strategy in patients after myocardial infarction

  • 期刊论文

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  • 发表日期：

    2025年2月24日

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  • Sander van der Brug,
  • Tinka van Trier,
  • Aaram Omar Khader,
  • An-ho Liem,
  • Astrid Schut,
  • Fabrice Martens,
  • Marco Alings

摘要

Objective

Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of developing atherosclerotic cardiovascular disease (ASCVD). In the PENELOPE study, a guideline-based, protocol-led LDL-C-lowering strategy was applied in patients after myocardial infarction and resulted in 87% reaching target LDL‑C levels of ≤ 1.8 mmol/l within a median of 45 days. This study evaluated PENELOPE’s legacy effect on LDL‑C levels after 1 year.

Methods

In the PENELOPE study, 999 patients with a myocardial infarction and a history of ASCVD and/or diabetes mellitus were included. If LDL-C > 1.8 mmol/l, lipid-lowering therapy was intensified in three consecutive steps: (1) high-intensity statin (HIST) monotherapy, (2) HIST + ezetimibe, and (3) HIST + ezetimibe + proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i). LDL‑C levels were monitored 4–6 weeks after each step. The primary objective of this study was to assess the prevalence of the LDL‑C target level of ≤ 1.8 mmol/l being maintained after 1 year.

Results

Data of 738 patients (74%) were available for 1‑year follow-up. The target LDL‑C level was met in 471 patients (64%). Median LDL‑C levels changed from 1.5 (1.2–1.7) mmol/l immediately after implementation of the protocol-led strategy to 1.6 (1.3–2.0) mmol/l after 1 year. Major treatment regimens were statin (58%), statin + ezetimibe (30%) and PCSK9i + ezetimibe (+ statin) (7%).

Conclusion

After a myocardial infarction, implementation of a protocol-led LDL-C-lowering strategy resulted in 87% of patients attaining the LDL‑C target level of ≤ 1.8 mmol/l within a median of 45 (32–77) days. At 1‑year follow-up, 64% maintained this target level and the median LDL‑C increased by 0.1 mmol/l.