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Atherosclerosis. 2017 Nov;266:158-166. doi: 10.1016/j.atherosclerosis.2017.08.013. Epub 2017 Aug 21.

Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II.

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Herzzentrum Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany. Electronic address:
Merck & Co., Inc., Kenilworth, NJ, USA.
Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France.
Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
Rutgers University, School of Public Health, Piscataway, NJ, USA.
MSD Ltd, Hoddesdon, UK.
Agile-1 for Merck & Co., Inc., Kenilworth, NJ, USA.
Institut für Herzinfarktforschung Ludwigshafen, Germany.
Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
National Taiwan University Hospital, Taipei, Taiwan and Fu-Jen Catholic University Hospital, Taipei, Taiwan.
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Center Singapore, National University Health System, Singapore.



Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS).


DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort).


A total of 10,661 patients were enrolled, 6794 with stable CHD and 3867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients, who were female, obese, or current smokers, were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely.


Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT.


Acute coronary syndrome; Cholesterol; Coronary heart disease; Dyslipidemias; Hydroxymethylglutaryl-CoA reductase inhibitors; LDL; Myocardial infarction; Unstable angina

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