THE IMPACT OF TARGETED LDL CHOLESTEROL CONTROL ON ANGINA SYMPTOMS AND LONG-TERM PROGNOSIS IN PATIENTS WITH ISCHEMIC HEART DISEASE: A LITERATURE REVIEW

Ischemic heart disease (IHD) remains one of the major manifestations of atherosclerotic cardiovascular disease and is associated with recurrent angina, myocardial infarction, coronary revascularization, heart failure, and cardiovascular mortality. Low-density lipoprotein cholesterol (LDL-C) plays a central causal role in the development and progression of atherosclerotic cardiovascular disease. Therefore, targeted reduction of LDL-C represents a fundamental component of secondary prevention in patients with IHD. The aim of this literature review was to evaluate the relationship between achieving LDL-C treatment targets, angina symptoms, and long-term cardiovascular prognosis in patients with IHD. Published randomized clinical trials, meta-analyses, and international clinical guidelines concerning LDL-C lowering were reviewed. Evidence indicates that more intensive LDL-C reduction is associated with a significant decrease in major cardiovascular events. Meta-analytic data demonstrate that each 1 mmol/L reduction in LDL-C is associated with approximately a 20–22% reduction in major vascular events [1, 2]. Clinical trials such as TNT and PROVE-IT TIMI 22 further demonstrated the benefits of intensive statin therapy [3, 4]. Additional LDL-C reduction with ezetimibe or PCSK9 inhibitors may provide further cardiovascular benefit in patients who remain above target despite maximally tolerated statin therapy [5, 6]. Although LDL-C lowering primarily improves long-term prognosis rather than providing an immediate anti-anginal effect, sustained lipid control may contribute to stabilization and regression of atherosclerotic plaques and consequently reduce recurrent ischemic events.