N Engl J Med
ACC 2026: Lower really is better—Pushing LDL below 55 mg/dL cuts CV events
Clinical takeaway: In patients with ASCVD who remain at high or very high risk, clinicians should actively titrate lipid‑lowering therapy to an LDL-C target <55 mg/dL when feasible, rather than stopping at <70 mg/dL.
Presented at ACC 2026, the randomized, open‑label Ez‑PAVE trial directly compared LDL-C targets in 3,048 patients with established ASCVD. Patients assigned to an intensive LDL-C goal of <55 mg/dL achieved a median LDL-C of 56 mg/dL, vs. 66 mg/dL in the conventional <70 mg/dL group. At three years, the intensive strategy reduced the primary composite endpoint (CV death, nonfatal MI, nonfatal stroke, revascularization, or unstable angina hospitalization) from 9.7% to 6.6%, reflecting a 33% relative risk reduction. Benefits were driven largely by fewer nonfatal MIs and revascularizations, with similar rates of adverse events between groups. The trial provides the strongest evidence to date that targeting lower LDL-C levels—rather than simply prescribing specific agents—improves outcomes in secondary prevention.
Source: Lee YJ, et al; Ez-PAVE Investigators. (2026, March 28). N Engl J Med. Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease