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

Clin Res Cardiol. 2023 Sep;112(9):1212-1219. doi: 10.1007/s00392-022-02147-3. Epub 2023 Jan 5.


Background and aims: Currently, less than 20% of patients at very high-risk achieve ESC/EAS dyslipidemia guideline-recommended LDL-C target levels in Europe. "Jena auf Ziel-JaZ" is a prospective cohort study in which early combination therapy with atorvastatin 80 mg and ezetimibe 10 mg was initiated on admission in patients with ST-elevation myocardial infarction (STEMI) and lipid-lowering therapy was escalated during follow-up with bempedoic acid and PCSK9 inhibitors to achieve recommended LDL-C targets in all patients. Moreover, we evaluated side-effects of lipid-lowering therapy.

Methods: Patients admitted with STEMI at Jena University Hospital were started on atorvastatin 80 mg and ezetimibe 10 mg on admission. Patients were followed for EAS/ESC LDL-C target achievement during follow-up.

Results: A total of 85 consecutive patients were enrolled in the study. On discharge, 32.9% achieved LDL-C targets on atorvastatin 80 mg and ezetimibe 10 mg. After 4-6 weeks, 80% of all patients on atorvastatin 80 mg and ezetimibe started at the index event were on ESC/EAS LDL-C targets. In 20%, combined lipid-lowering therapy was escalated with either bempedoic acid or PCSK9 inhibitors. All patients achieved LDL-C levels of or below 55 mg/dL during follow-up on triple lipid-lowering therapy. Combined lipid-lowering therapy was well-tolerated with rare side effects.

Conclusions: Early combination therapy with a high-intensity statin and ezetimibe and escalation of lipid-lowering therapy with either bempedoic acid or PCSK9 inhibitors gets potentially all patients with STEMI on recommended ESC/EAS LDL-C targets without significant side effects.

Keywords: LDL cholesterol; LDL cholesterol target attainment; ST-elevation myocardial infarction; Secondary prevention.

MeSH terms

  • Anticholesteremic Agents* / adverse effects
  • Atorvastatin / adverse effects
  • Cholesterol, LDL
  • Ezetimibe / adverse effects
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
  • PCSK9 Inhibitors
  • Proprotein Convertase 9 / therapeutic use
  • Prospective Studies
  • ST Elevation Myocardial Infarction* / diagnosis
  • ST Elevation Myocardial Infarction* / drug therapy
  • Treatment Outcome


  • 8-hydroxy-2,2,14,14-tetramethylpentadecanedioic acid
  • PCSK9 protein, human
  • Proprotein Convertase 9
  • Atorvastatin
  • Anticholesteremic Agents
  • Cholesterol, LDL
  • PCSK9 Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Ezetimibe