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Atherosclerotic Cardiovascular DiseaseNCT05765370

LDL Cholesterol TARGETs in OLDer Patients (Age≥75 Years) With ASCVD (TARGET OLD)

A study testing Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dL and Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dL in people with Atherosclerotic Cardiovascular Disease and Older Patients, run by China National Center for Cardiovascular Diseases at 1 site in China.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
Search all trials

Trial summary

To determine whether treating to an LDL-C target of 25 to <70 mg/dL is superior to an LDL-C target of 70 to <100 mg/dL with respect to major cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization) in patients aged ≥75 years with… Read more about this study

Who is it for?
Ages 75 years and older
What is being tested?
Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dL and Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dL
Type of treatment
Surgery or procedure
Could I receive a placebo?
No, everyone receives an active treatment
How many people
4,200 participants
Where
1 siteChina
Study dates
24 Mar 2023to 24 Dec 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 75 years and older
  • All sexes
  • No healthy volunteers
  • Older adult

Who may be able to join

  • Men or women ≥75 years of age
  • Diagnosis of clinical atherosclerotic cardiovascular disease (ASCVD) with one or more of the following:
  • Diagnosis of coronary heart disease (one or more of the following criteria must be satisfied):
  • Hospitalization for acute coronary syndrome
  • Treatment or hospitalization for stable angina pectoris with documented ischemia on invasive or noninvasive testing
  • History of myocardial infarction
Show all 24Show fewer
  • History of coronary revascularization procedure (eg, percutaneous coronary intervention [PCI] or coronary artery bypass graft surgery [CABG])
  • Invasive diagnostic coronary angiography indicating >50% stenosis in at least one major epicardial coronary artery or CT-imaging (eg, CCTA/MDCT) evidence of coronary atherosclerosis (>50% stenosis in at least two major epicardial coronary artery)
  • Diagnosis of atherosclerotic cerebrovascular or carotid disease (one or more of the following criteria must be satisfied):
  • History of ischemic stroke or transient ischemic attack (TIA) confirmed by symptoms with a documented ischemic lesion on CT or MRI in the cerebral regions corresponding to the symptoms;
  • Documented intracranial atherosclerotic stenosis on the basis of conventional cerebral angiography, magnetic resonance angiography, CT angiography, transcranial doppler ultrasound, and high-resolution MRI;
  • Symptomatic carotid artery disease with ≥50% carotid arterial stenosis;
  • Asymptomatic carotid artery disease with ≥70% carotid arterial stenosis per angiography or duplex ultrasound;
  • History of carotid revascularization (catheter-based or surgical).
  • Diagnosis of atherosclerotic peripheral artery disease (one or more of the following criteria must be satisfied):
  • History of aorto-iliac or peripheral arterial intervention (catheter-based or surgical).
  • Prior non-traumatic amputation of a lower extremity due to peripheral artery disease
  • History of intermittent claudication and one or more of the following:
  • An ankle/arm blood pressure (BP) ratio < 0.90, or
  • Significant peripheral artery stenosis (≥50%) documented by angiography, or by duplex ultrasound
  • Baseline LDL-C level should be satisfied:
  • Patients were required to have a baseline LDL-C level ≥100mg/dL (2.6mmol/L) if they were taking a regimen of lipid-lowering therapy <4 weeks or they had not previously received lipid-lowering therapy.
  • Patients were required to have a baseline LDL-C level ≥70mg/dL (1.8mmol/L) if they were on stable treatment with lipid-lowering therapy ≥4 weeks
  • Signed written informed consent.

Who cannot join

  • Subject was clinically unstable:
  • Hypotension, defined as sustained systolic blood pressure of <90 mmHg due to cardiac failure with associated symptoms;
  • Unstable or severe pulmonary edema/decompensated congestive heart failure;
  • Acute mitral regurgitation or acute ventricular septal defect;
  • Cardiogenic shock and/or need for mechanical/pharmacologic hemodynamic support
  • Ongoing Non-STEMI with biomarkers (cardiac troponin) still rising
Show all 25Show fewer
  • Recent STEMI (≤7 days prior to randomization)
  • Recurrent symptoms of cardiac ischemia
  • Moderate to severe heart failure (New York Heart Association [NYHA] Functional Classification III or IV) or last known left ventricular ejection farction (LVEF) <40%.
  • Severe renal dysfunction, defined as creatinine clearance <30 mL/min or estimated glomerular filtration (eGFR) rate less than 30 ml/min/1.73 m2, or requirement for peritoneal dialysis or hemodialysis for renal insufficiency.
  • History of hemorrhagic stroke or unknown classified stroke.
  • Uncontrolled or recurrent ventricular tachycardia (such as ventricular fibrillation, recurrent and highly symptomatic ventricular tachycardia, complete heart block, atrial fibrillation with rapid ventricular response, or supraventricular tachycardia that are not controlled by medications).
  • Uncontrolled hypertension (greater than 180 mm Hg systolic and/or greater than 110 mm Hg diastolic at randomization visit).
  • History or clinical evidence of active liver disease or hepatic dysfunction, defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 3 × upper limit of normal (ULN), or total bilirubin > 2 × ULN.
  • Unexplained elevated creatine kinase (CK) concentration >5 × ULN or elevation due to known muscle disease.
  • Planned or expected cardiac surgery, PCI or carotid stenting, or planned major noncardiac surgery during the study period. If angiography or revascularization is planned, patients may be screened and enrolled after all such planned procedures are completed.
  • Active Malignancy (except nonmelanoma skin cancers, cervical in-situ carcinoma, breast ductal carcinoma in situ, or stage 1 prostate carcinoma) including those patients requiring surgery, chemotherapy, and/or radiation in the past 3 years.
  • Drug or alcohol abuse, and inability/unwillingness to abstain from drug abuse and excessive alcohol consumption during the study.
  • Severe, concomitant noncardiovascular disease that is expected to reduce life expectancy to <3 years
  • Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study(ies), or receiving other investigational agent(s)
  • Subject has received drugs via a systemic route that have known major interactions with background statin therapy (eg, itraconazole, ketoconazole, and other antifungal azoles, erythromycin, clarithromycin, or cyclosporine nefazodone) within 1 month prior to randomization or is likely to require such treatment during the study period.
  • Recipient of any major organ transplant (eg, lung, liver, heart, bone marrow, renal)
  • Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures (eg, Clinical Outcome Assessments) to the best of the subject and investigator's knowledge.
  • Any uncontrolled or serious disease, or any medical or surgical condition (such as known active infection or major hematologic, renal, metabolic, gastrointestinal or endocrine dysfunction, or a chronic disease or infection [eg, HIV]), that may either interfere with participation in the clinical study and is not currently stable and appropriately managed in the judgment of the investigator, and/or put the subject at significant risk (according to investigator's judgment) if he/she participates in the clinical study.
  • Mental/psychological impairment/neurocognitive disorder, or any other reason to expect patient difficulty in complying with the requirements of the study or understanding the goal and potential risks of participating in the study

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Kefei Dou, MD, PhD contact

+86-10-13801032912

drdoukefei@126.com

Hao-Yu Wang, MD, PhD contact

+86-10-15810671272

wanghaoyu@fuwai.com

China1 site, 1 recruiting

  • Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College

    Beijing, Beijing Municipality, 100037

    Kefei Dou, MD, +86-13801032912, drdoukefei@126.com

    Hao-Yu Wang, MD, +86-15810671272, wanghaoyu@fuwai.com

    Recruiting

Other trials in China

About this study

Official title: LDL Cholesterol TARGETs in OLDer Patients (Age≥75 Years) With Atherosclerotic Cardiovascular Disease (TARGET OLD)

To determine whether treating to an LDL-C target of 25 to <70 mg/dL is superior to an LDL-C target of 70 to <100 mg/dL with respect to major cardiovascular events (cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization) in patients aged ≥75 years with atherosclerotic cardiovascular disease (ASCVD).

To determine whether treating to an LDL-C target of 25 to <70 mg/dL is non-inferior to an LDL-C target of 70 to <100 mg/dL with respect to major safety events (hemorrhagic stroke, new-onset diabetes, muscle-related events, neurocognitive adverse events, new or recurrent cancer, cataract, or hepatic disorder [Alanine aminotransferase (ALT)/Aspartate aminotransferase (AST) >3× ULN, or total bilirubin >2× ULN]) in patients aged ≥75 years with ASCVD.

Read the detailed description

The benefits of LDL cholesterol-lowering treatment for the prevention of atherosclerotic cardiovascular disease (ASCVD) are well established. LDL-C lowering is associated with a significant reduction in major adverse cardiovascular events in a linear fashion, apparently without any plateau at low LDL-C levels. On the other hand, the degree to which LDL-C levels can be safely lowered remains unclear. It is still controversial whether lower LDL-C levels are associated with significant clinical adverse effects (e.g. new-onset diabetes mellitus or possibly hemorrhagic stroke) and long-term data are needed to address safety concerns.

It should be noted that the benefits and risks from LDL cholesterol lowering in older patients (age ≥75 years) remains debated because most randomized trials have explicitly excluded or enrolled few older adults. In clinical practice, the appropriate treatment target for LDL-C in patients ≥75 years of age with ASCVD remains uncertain. Current US and European cholesterol guidelines have no specific recommendations regarding the LDL-C treatment goal for older patients and noted that the level of evidence in older patients is low. Currently, there is no direct evidence from randomized clinical trials (RCTs) for the most appropriate treatment targets for LDL-C among patients ≥75 years of age with ASCVD in worldwide.

The TARGET OLD trial is a multicenter, open-label, parallel-group, event-driven, randomized, controlled trial with blinded end-point evaluation. Consecutive patients aged ≥75 years with ASCVD who meet the inclusion criteria and none of the exclusion criteria outlined above will be randomized in a 1:1 fashion to LDL-C target of 25 to <70 mg/dL or LDL-C target of 70 to <100 mg/dL. The proposed study will examine the comparative efficacy and safety of treating to an LDL-C target of 25 to <70 mg/dL compared with an LDL-C target of 70 to <100 mg/dL among patients aged 75 years or older with ASCVD. Our primary hypothesis is that, among such patients, targeting an LDL-C of 25 to less than 70 mg/dL is superior to a target of 70 to less than 100 mg/dL on reducing the risk of major adverse cardiovascular events (primary efficacy end point), while is non-inferior towards the composite of major safety outcomes (key secondary safety end point).

Prescription of lipid-lowering agents (drug and dosage up to the investigator according to the assigned target LDL-C level. Statin monotherapy or in combination with ezetimibe, PCSK9 inhibitor or other drugs were adjusted on the basis of the study-group assignment. Patients will follow-up at 1, 2, 4, 6, 12 months, and then every 6 months throughout 36 months with an evaluation of patients' lipid profiles, any cardiovascular events, safety and adverse events, muscle-related symptoms, quality of life (EQ-5D), and patient-reported cognition function (ECog scale). The trial will continue until 726 adjudicated primary endpoint events have occurred. We estimated that 4,200 patients would be needed to provide the necessary number of confirmed endpoints to test the study hypothesis. All analyses will be according to the intention-to-treat (ITT) principle.

Being tested
Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dL, Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dL
Keywords
LDL-C target, Atherosclerotic Cardiovascular Disease, Older patients, Age≥75 years, Lipid-lowering therapy, Stain, PCSK9 inhibitor
Medical subject headings
Atherosclerosis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dLProcedure or surgery

    Investigators initiated or adjusted lipid-lowering agents (drug and dosage) to achieve the target of 25mg/dL≤ LDL-C<70mg/dL. The protocol encouraged, but did not mandate, the initiation of moderate-intensity statin therapy for secondary prevention with the evaluation of the potential for ASCVD risk reduction, adverse effects, and drug-drug interactions, as well as patient frailty and patient preferences. Statin monotherapy or in combination with ezetimibe, PCSK9 inhibitor or other drugs were adjusted on the basis of LDL-C levels.

    At each follow-up visit, the investigators should verify whether the target LDL-C has been obtained. If the target level of LDL cholesterol was achieved, it is reasonable to continue to monitor adherence to lifestyle modifications, medication, and ongoing LDL-C response to therapy. If the target level of LDL cholesterol was not achieved, adjustment of the type and dose regimen of statin, or the additional of a nonstatin agent should be considered.

  • Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dLProcedure or surgery

    Investigators initiated or adjusted lipid-lowering agents (drug and dosage) to achieve the target of 70mg/dL≤ LDL-C<100mg/dL. The protocol encouraged, but did not mandate, the initiation of moderate-intensity statin therapy for secondary prevention with the evaluation of the potential for ASCVD risk reduction, adverse effects, and drug-drug interactions, as well as patient frailty and patient preferences. Statin monotherapy or in combination with ezetimibe, PCSK9 inhibitor or other drugs were adjusted on the basis of LDL-C levels.

    At each follow-up visit, the investigators should verify whether the target LDL-C has been obtained. If the target level of LDL cholesterol was achieved, it is reasonable to continue to monitor adherence to lifestyle modifications, medication, and ongoing LDL-C response to therapy. If the target level of LDL cholesterol was not achieved, adjustment of the type and dose regimen of statin, or the additional of a nonstatin agent should be considered.

Study groups in NCT05765370
Study groupRoleWhat they receive
LDL-C Lower-Target Group (25mg/dL≤ LDL-C<70mg/dL)ExperimentalParticipants randomized into the LDL-C lower-target arm will have a goal of 25mg/dL≤ LDL-C<70mg/dL. Prescription of lipid-lowering agents (drug and dosage) were initiated or adjusted on the basis of the investigator according to the assigned target LDL-C level.
Receives: Procedure: Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dL
LDL-C Higher-Target Group (70mg/dL≤ LDL-C<100mg/dL)Active comparatorParticipants randomized into the LDL-C lower-target arm will have a goal of 70mg/dL≤ LDL-C<100mg/dL. Prescription of lipid-lowering agents (drug and dosage) were initiated or adjusted on the basis of the investigator according to the assigned target LDL-C level.
Receives: Procedure: Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dL

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Time to first occurrence of major cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, coronary revascularization)

    The primary endpoint measure was the number of patients with a first occurrence of adjudicated composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months

Secondary outcomes (12)

  1. Time to first occurrence of major safety events (composite of hemorrhagic stroke, new-onset diabetes, muscle-related events, neurocognitive adverse events, new or progressive cancer, cataract, or hepatic disorder).

    The key secondary endpoint measure was the number of patients with a first occurrence of adjudicated composite of hemorrhagic stroke, new-onset diabetes, muscle-related events, neurocognitive adverse events, new or progressive cancer, cataract, or hepatic disorder (ALT/AST >3× ULN, or total bilirubin >2× ULN) during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months

  2. Time to first occurrence of composite endpoint of cardiovascular death, myocardial infarction, stroke, or coronary revascularization.

    Number of patients with a first occurrence of adjudicated composite of cardiovascular death, myocardial infarction, stroke, or coronary revascularization during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  3. Time to first occurrence of composite endpoint of cardiovascular death, myocardial infarction, or stroke.

    Number of patients with a first occurrence of adjudicated composite of cardiovascular death, myocardial infarction, or stroke during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  4. Time to first occurrence of composite endpoint of all-cause death, myocardial infarction, or stroke.

    Number of patients with a first occurrence of adjudicated composite of all-cause death, myocardial infarction, or stroke during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  5. Time to first occurrence of composite endpoint of cardiovascular death or myocardial infarction.

    Number of patients with a first occurrence of adjudicated composite of cardiovascular death or myocardial infarction during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  6. Time to first occurrence of composite endpoint of all-cause death or myocardial infarction.

    Number of patients with a first occurrence of adjudicated composite of all-cause death or myocardial infarction during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  7. Time to first occurrence of myocardial infarction.

    Number of patients with a first occurrence of adjudicated myocardial infarction during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  8. Time to first occurrence of coronary revascularization.

    Number of patients with a first occurrence of adjudicated coronary revascularization during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  9. Time to cardiovascular death.

    Number of patients with an occurrence of cardiovascular death during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  10. Time to first occurrence of stroke.

    Number of patients with a first occurrence of stroke during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  11. Time to first occurrence of hospitalization for unstable angina.

    Number of patients with a first occurrence of hospitalization for unstable angina during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

  12. Time to all-cause death.

    Number of patients with an occurrence of all-cause death during the follow-up period.

    Measured: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Mar 2023
  2. Study start24 Mar 2023
  3. Primary completion24 Sep 2026 (estimated)
  4. Study completion24 Dec 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
4,200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05765370
Sponsor's protocol ID
2022-1879
Status last verified
Mar 2023
First submitted
1 Mar 2023
Last updated
10 Apr 2023
Results posted
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Questions about this trial

What is this clinical trial studying?

A study testing Achieving a Target LDL-C level of 25mg/dL≤ LDL-C<70mg/dL and Achieving a Target LDL-C level of 70mg/dL≤ LDL-C<100mg/dL in people with Atherosclerotic Cardiovascular Disease and Older Patients, run by China National Center for Cardiovascular Diseases at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 24 inclusion and 25 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 10 Apr 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Kefei Dou, MD, PhD (+86-10-13801032912, drdoukefei@126.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Time to first occurrence of major cardiovascular events (composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, coronary revascularization) (time frame: From randomization until study completion (until 726 adjudicated primary endpoint events have occurred); for approximately a median follow-up of 42 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05765370.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Apr 2023.

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