The Importance of LDL Cholesterol Management After a Heart Attack

Hello everyone! Today, let's dive into the strategies for managing LDL cholesterol after experiencing a heart attack or unstable angina. These two conditions are emergency situations caused by sudden blockages or narrowing of the heart's arteries. Even after overcoming the critical phase, the treatment isn't over. If the underlying causes of vascular damage aren't properly managed post-discharge, the risk of recurrence increases significantly, with the first year after discharge being particularly high-risk.

During this crucial period, effectively lowering and maintaining low levels of LDL cholesterol, often referred to as 'bad cholesterol,' is considered the cornerstone of treatment. Recently, clinical results have emerged showing that Leqvio, an RNA (ribonucleic acid)-based therapy, can help rapidly reduce LDL-C and sustain target levels in these high-risk patients.

Leqvio's Efficacy and Clinical Study Findings

Novartis Korea announced that Leqvio demonstrated its ability to help patients achieve and sustain their LDL-C target levels faster in the recent global clinical study, VICTORION-INCEPTION, which focused on patients who recently experienced a heart attack or unstable angina. These study findings have been published in the prestigious international journal, the Journal of the American College of Cardiology.

The study included 400 patients who were hospitalized for a heart attack or unstable angina and discharged within five weeks. These participants had an LDL-C level of 70 mg/dL or higher, or a non-HDL cholesterol level of 100 mg/dL or higher. The researchers compared a group receiving Leqvio in combination with standard therapy against a group receiving standard therapy alone, closely mimicking real-world clinical practice.

Key Takeaways from the Study Results

• In the Leqvio combination group, LDL-C decreased by 45.6% compared to pre-treatment levels.
• In contrast, the standard therapy alone group saw an increase of 1.4%.
• The percentage of patients achieving an LDL-C level below 70 mg/dL was 66.7% in the Leqvio combination group, compared to 28.1% in the standard therapy group.
• Notably, 74.6% of patients in the Leqvio combination group reached an LDL-C level below 70 mg/dL within 90 days of treatment initiation.

How RNA Therapies Work

Leqvio is an siRNA (small interfering RNA) based therapy. It works by modulating the process of genetic information transfer that instructs the creation of specific proteins, thereby reducing the production of disease-related proteins. The target of this medication is the PCSK9 protein. When PCSK9 levels increase, the liver's ability to clear LDL-C from the blood can be impaired. Leqvio helps by inhibiting the production of PCSK9, enabling the liver to remove LDL-C more effectively.

Furthermore, Leqvio is administered via injection by a healthcare professional. After the initial dose, a second dose is given three months later, followed by injections twice a year thereafter. This dosing regimen can offer advantages in terms of medication adherence and treatment persistence.

The Significance of Treatment Strategies

The American College of Cardiology and the American Heart Association, in their 2025 Guideline for the Management of Acute Coronary Syndromes, recommend intensive lipid-lowering therapy immediately after discharge for high-risk ACS patients. For patients whose LDL-C remains above 70 mg/dL despite maximally tolerated statin therapy, the guidelines recommend adding non-statin lipid-lowering therapies, including Leqvio.

Professor Yong-Joon Lee from the Division of Cardiology at Severance Cardiovascular Hospital explained, "For patients with acute coronary syndrome, managing the risk of recurrence from the early stages after discharge is paramount. However, traditional stepwise treatment approaches have often made it difficult to rapidly reach LDL-C goals." He expressed optimism that Leqvio could be a valuable tool for sustained LDL-C management in high-risk patients.

For patients who have experienced a heart attack or unstable angina, cholesterol management is more than just controlling numbers. It's a crucial preventive measure to avoid further vascular blockages and recurrence. The emergence of RNA therapies as a new option for rapidly and durably lowering LDL-C in high-risk individuals is certainly noteworthy.