Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor and director of the Pauley Heart Center, VCU Health in Richmond, Virginia. Well, Carolyn, this week's feature involves interleukin-6 and a phenome-wide association study. So we have a lot to look forward to, but before we do that, how about we grab a cup of coffee and jump into the other articles in this issue? I could start first because I've got to tell you about some results from the ODYSSEY outcomes trial. And Carolyn, this comes to us from Professor Gregory Schwartz at the University of Colorado School of Medicine. Well, Carolyn, this study pertains to LDL lowering. As you know, recent international guidelines have lowered the recommended target levels of LDL cholesterol for patients at very high risk for major cardiovascular events or MACE. Dr. Greg Hundley: However, uncertainty persists as to whether additional benefit results from achieving LDL-c levels below some of these conventional targets. Now inferences from prior analyses are limited because patients who achieve lower versus higher LDL-c on lipid lowering therapy differ in other characteristics prognostic for MACE, and because few achieved very, very low LDL-c levels. So to overcome these limitations, these authors performed a propensity score matching analysis of the ODYSSEY outcomes trial, which compared alirocumab with placebo in 18,924 patients with recent acute coronary syndrome receiving intensive or maximum tolerated statin treatment. Dr. Carolyn Lam: Sensible question, and what did they find? Dr. Greg Hundley: Well, Carolyn, the main finding of the study was that after accounting for differences in baseline characteristics and adherence, patients treated with alirocumab who achieved LDL-c levels less than 25 milligrams per deciliter did not appear to derive further reduction in the risk of MACE compared to those who achieved LDL-c levels of say 25 to 50 milligrams per deciliter. So, Carolyn, the take-home message is that recent international guidelines have lowered LDL-c goals for patients at very high risk for MACE to levels less than 55 milligrams per deciliter, and in some cases, maybe less than 40 milligrams per deciliter. However, any potential benefit of achieving LDL-c levels significantly below these goals to those very low, less than 25 really remains uncertain. Dr. Carolyn Lam: Very interesting. Thanks Greg. Well, my paper is about the HOST-REDUCE-POLYTECH-ACS trial. Got your attention? All right. I'll tell you what it is. It's an investigator-initiated, randomized, open-label, adjudicator-blinded, multicenter, non-inferiority trial, which compared the efficacy and safety of durable polymer versus biodegradable polymer, drug-eluting stents. And these investigators led by Kyung Woo Park from Seoul National University Hospital looked at 3,413 patients with acute coronary syndrome. At 12 months, the primary endpoint of patient oriented composite outcome, which was a composite of all-cause death, nonfatal myocardial infarction, and any repeat revascularization, occurred in 5.2% of the durable polymer group and 6.4% of the biodegradable polymer group. And so that met the non-inferiority P value of less than 0.01. the key secondary end points of device oriented composite outcome, which is a composite of cardiac death, target vessel MI, or target lesion revascularization occurred less frequency in the durable polymer versus biodegradable polymer groups, and this was mostly due to a reduction in target lesion revascularization. The spontaneous nonfatal MI and stent thrombosis rates were very low with no significant difference between the groups. Dr. Greg Hundley: Well, Carolyn, you know one of my favorite questions, so what's the tak