Introduction: Lipid lowering therapy - despite the accumulated clinical trial evidence behind it and its significant preventive role reflected in the guidelines - does not have its rightful place in the value system of patients or doctors, there is a great gap between practice and principles. Objective: In order to increase the prestige of lipid-lowering therapy, the potential benefit of lowering LDL cholesterol was compared with antiplatelet therapy, which is generally more accepted. Method: We processed the data of 531 patients of the Bekes County Central Hospital Pandy Kalman Branch in Gyula who underwent percutaneous coronary intervention for acute coronary syndrome for one year starting on April 1, 2020. A simulation study was conducted during which, based on the results of large clinical studies, the cardiovascular prevention effect of optimal lipid reduction and platelet aggregation inhibition for one year was estimated. Results: In all 531 patients treated for acute coronary syndrome, if LDL cholesterol levels had remained at the mean level of 3.37 mmol/L found at admission, 59 major cardiovascular events could have occurred within one year after the index event. If LDL-cholesterol levels were to be reduced to 1.4 mmol/L, which is the very high-risk target value in the lipid recommendations of the European Society of Cardiology, the number of events would be 13, and 16 if the theoretical, very low, non-target value of 0.5 mmol/L was reached. Lowering LDL cholesterol levels is therefore expected to avoid 13 and 16 major cardiovascular events, respectively. If aspirin alone was given for antiplatelet aggregation, 14 events could be prevented over a year, 17 events could be prevented using aspirin and clopidogrel combination, and 20 events with aspirin and prasugrel or aspirin and ticagrelor. Discussion: Based on the low rates of achieving LDL cholesterol targets, there is a considerable potential for optimizing lipid-lowering treatment worldwide. In patients with acute coronary syndrome, one of the most vulnerable patient groups in cardiology practice, the study results suggest that lipid reduction and platelet aggregation inhibition could achieve a similar reduction in the number of major cardiovascular events. Conclusion: The simulation study confirms the comparable cardiovascular benefit of the two interventions. Since the attainment rate of LDL cholesterol targets set in the guidelines is very poor - with physicians' therapeutic inertia playing a major role -, we hope our findings will convince colleagues that more attention should be paid to more optimal lipid reduction.

Purpose: Limited real-world data are available on the survival of patients treated with vitamin K antagonists (VKAs) versus with direct oral anticoagulants (DOACs) for nonvalvular atrial fibrillation (AF). In this nationwide registry, we analyzed the mortality risk of patients with nonvalvular AF taking DOACs versus VKAs, with a special attention to the early treatment period. Methods: The Hungarian National Health Insurance Fund (NHIF) database was searched to identify patients treated with VKA or DOAC as a thromboembolic prophylaxis for nonvalvular AF between 2011 and 2016. The overall and the early (0–3, 4–6, and 7–12 months) mortality risks with the 2 types of anticoagulation were compared. A total of 144,394 patients with AF treated with either a VKA (n = 129,925) or a DOAC (n = 14,469) were enrolled. Findings: A 28% improvement in 3-year survival with DOAC treatment compared with VKA treatment was shown. Mortality reduction with DOACs was consistent across different subgroups. However, younger patients (30–59 years old) initiated on DOAC therapy had the greatest RRR (53%) in mortality. Furthermore, DOAC treatment also yielded a benefit of greater magnitude (HR = 0.55; 95% CI, 0.40–0.77, P = 0.001) in the lower (0-1) CHA2DS2-VASc score segment and in those with fewer (0–1) bleeding risk factors (HR = 0.50, CI 0.34–0.73, P = 0.001). The RRR in mortality with DOACs was 33% within the first 3 months, and 6% in the second year. Implications: Thromboembolic prophylaxis with DOACs in this study yielded significantly lower mortality compared with VKA treatment in patients with nonvalvular AF. The largest benefit was shown in the early period after treatment initiation, as well as in younger patients, those with a lower CHA2DS2-VASc score, and those with fewer bleeding risk factors.