ArticleFrontiers in cardiovascular medicine2026
Early escalation of oral lipid-lowering therapy to achieve LDL-cholesterol targets in patients after myocardial infarction: study protocol for the prospective, open-label HAnnover ChOlesterol Lowering in Acute Coronary Syndrome trial.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Contemporary registry data indicate that only 20%-25% of patients following acute myocardial infarction achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) values <1.4 mmol/L (55 mg/dL). The present study aims to evaluate the impact of early intensive therapy (potent statin + ezetimibe ± bempedoic acid) on lipid control after myocardial infarction. Methods: This is a prospective, interventional, single-center study designed to assess the effectiveness of bempedoic acid in achieving LDL-C targets in patients following ST-elevation or non-ST-elevation myocardial infarction who remain insufficiently treated with atorvastatin plus ezetimibe. Patients not previously treated with lipid-lowering agents and presenting with admission LDL-C > 2.6 mmol/L (100 mg/dL) will be treated with atorvastatin (at least 40 mg/day or equivalent) plus ezetimibe (10 mg/day) for 6 weeks. Thereafter, the subgroup of patients failing to reach an LDL-C < 1.4 mmol/L (55 mg/dL) will be escalated to additive bempedoic acid (180 mg/day) for another 8 weeks. Those who reach the target will continue the aforementioned therapy. The primary endpoint is the proportion of patients who successfully achieve an LDL-C < 1.4 mmol/L (55 mg/dL) after 8 weeks of treatment with triple therapy. Secondary endpoints include the proportion of patients successfully reaching the target in the overall population and in the background medication group alone. Discussion: The results of this study will provide novel insights into post-infarction LDL-C control by evaluating the usefulness of an early intensive escalation oral lipid-lowering treatment strategy. Early intensive lipid-lowering triple oral therapy may facilitate the achievement of guideline-recommended LDL-C levels within the first 3 months after myocardial infarction compared with current clinical practice. Clinical Trial Registration: EudraCT 2022-003526-50.
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