Intensive lipid-lowering therapy for early achievement of guideline-recommended LDL-cholesterol levels in patients with ST-elevation myocardial infarction (“Jena auf Ziel”)
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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. Graphical abstract:
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In secondary prevention patients with ASCVD, a subgroup of 8 patients on high-intensity atorvastatin plus ezetimibe achieved a 15.0% LDL-C reduction at 1 month after escalation to bempedoic acid.
“In secondary prevention patients with ASCVD, a small subgroup of patients (n = 8) already on high-intensity atorvastatin plus ezetimibe achieved a 15.0% LDL-C reduction at 1 month after escalation to bempedoic acid (baseline LDL-C = 124 mg/dL) [25].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [25]
The Results (‘LDL-C target attainment’; page not provided) report that eight patients receiving atorvastatin 80 mg and ezetimibe 10 mg had an additional 15% LDL-C reduction after bempedoic acid was added. The paper does not specify that this reduction was measured one month after escalation. Its baseline LDL-C of approximately 124 mg/dL is reported for the full STEMI cohort, not specifically for those eight patients. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLDL-C reductions with bempedoic acid added to statins ranged from 15% to 39%.
“Consistent effects were also seen when bempedoic acid was added to statins (15% to 39%) [25,30,32,38,39,44], and when used in statin intolerant patients (22% to 38%) [24,29,34,35,37,40,41], despite the latter group having higher baseline LDL-C.”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [25]
The Results (LDL-C target attainment; page unavailable) report an additional 15% LDL-C reduction when bempedoic acid was added to atorvastatin and ezetimibe in eight patients after STEMI. Our copy does not report a 39% reduction with bempedoic acid, so this paper supports the lower endpoint but not the attributed range. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn secondary prevention patients with ASCVD, among a small subgroup (n = 8) already on high-intensity atorvastatin plus ezetimibe, all patients escalated to bempedoic acid achieved an LDL-C target of <54 mg/dL within 1.5 months of follow-up (baseline LDL-C = 124 mg/dL).
“In secondary prevention patients with ASCVD, among a small subgroup of patients (n = 8) already on high-intensity atorvastatin plus ezetimibe, all patients escalated to bempedoic acid achieved an LDL-C target of <54 mg/dL within 1.5 months of follow-up (baseline LDL-C = 124 mg/dL) [25].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [25]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredReal-world LDL-C reductions with bempedoic acid in secondary prevention populations ranged from 15% to 39%.
“These reductions were reported across both primary (23% to 39%) [24,29,44] and secondary prevention populations (15% to 39%) [25,32,38,39].”
From Systematic literature review on the real-world effectiveness and safety of bempedoic acid (2026) · cites this paper as [25]
The Results (LDL-C target attainment; page unavailable) report an additional 15% LDL-C reduction after bempedoic acid was added for eight patients after STEMI. This supports the lower end of the cited range in a secondary-prevention population, but the paper does not report a 39% bempedoic-acid reduction. (LLM, conf=0.88)
Experimental — accuracy not yet measured
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References 30 · Cited by 52
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- Authors
- Makhmudova, U., Samadifar, B., Maloku, A., Haxhikadrija, P., Geiling, J.-A., Römer, R., Lauer, B., Möbius-Winkler, S., Otto, S., Schulze, P. C., & Weingärtner, O.
- Affiliations
- Jena University Hospital (DE)
- Corresponding author
- Weingärtner, Oliver
- Venue
- Clinical Research in Cardiology
- Published
- 2023-01-05
- Volume
- 112
- Issue
- 9
- Pages
- 1212-1219
- ISSN
- 1861-0684 (ISSN-L)
- 1861-0692
- PMC
- PMC10449699
- OpenAlex
- W4313545259
- Cited by
- 52
- References
- 30
- Citations by year
- 2026: 13 · 2025: 20 · 2024: 10 · 2023: 9
- FWCI
- 13.93
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Clinical Research in Cardiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Common Library Network (Der Gemeinsame Bibliotheksverbund) (submittedVersion, cc-by)
- Funders
- Universitätsklinikum Jena
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- ST-elevation myocardial infarction, intensive lipid-lowering therapy, LDL cholesterol targets, ezetimibe, bempedoic acid, PCSK9 inhibitors, dyslipidemia, statin adverse effects, very high-risk patients
- MeSH terms
- Atorvastatin, Ezetimibe, Proprotein Convertase 9, ST Elevation Myocardial Infarction, PCSK9 Inhibitors, Anticholesteremic Agents, Dicarboxylic Acids, Fatty Acids, Humans, Cholesterol, LDL, Prospective Studies, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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