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This article discusses the results of six randomized trials that examined the effects of fibrates and gemfibrozil on the prevention of atherosclerotic cardiovascular disease (ASCVD). The trials showed inconsistent results, and the authors sought to understand these discrepancies by examining the effects of mass changes in remnant cholesterol and LDL cholesterol. Using the Copenhagen General Population Study (CGPS) to mimic the study population of these trials, the authors compared estimated changes in ASCVD risk through mass changes in cholesterol with the observed changes in the original trials. The results suggest that mass changes in total atherogenic cholesterol can explain the results of these trials, regardless of whether statins were used or not. The authors conclude that to reduce ASCVD, cholesterol-lowering agents should aim to reduce the total mass of atherogenic cholesterol. [Extracted from the article]

Said differently, LDL cholesterol cannot be too low after a myocardial infarction and all patients with a myocardial infarction should receive LDL cholesterol-lowering medication post myocardial infarction irrespective of their LDL cholesterol levels at the time of the infarct. Just as age - these comorbidities increase the risk of dying during follow-up for patients with low LDL cholesterol at myocardial infarction compared with those with high LDL cholesterol at myocardial infarction. Elevated low-density lipoprotein (LDL) cholesterol is a causal risk factor for the development of atherosclerosis and drives an increased risk of both myocardial infarction and early death. [Extracted from the article]