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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Evolving concepts on the management of dyslipidaemia
Olivier S Descamps1, Ann Verhaegen2, Fabien Demeure3
1Department of internal medicine, Centres Hospitaliers Jolimont, Haine Saint-Paul and department of cardiology, UCL Cliniques Universitaires Saint-Luc, Bruxelles, Belgium.
Insights
Lowering low-density lipoprotein cholesterol (LDL-C) as much as possible is key to preventing atherosclerotic cardiovascular disease (ASCVD). New guidelines emphasize maximizing LDL-C reduction, even to very low levels, which appears safe and beneficial for high-risk patients.
Area of Science:
- Cardiology
- Lipidology
- Preventive Medicine
Background:
- Low-density lipoproteins (LDL) are causally linked to atherosclerotic cardiovascular disease (ASCVD).
- Lowering LDL cholesterol (LDL-C) demonstrably reduces ASCVD risk.
- No safe LDL-C threshold exists below which ASCVD prevention benefits plateau.
Purpose of the Study:
- To review recent advancements in lipidology over the past decade.
- To describe key updates in the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines.
- To highlight the shift towards a benefit-based strategy in ASCVD prevention.
Main Methods:
- Review of current literature and recent concepts in lipidology.
- Analysis of the 2019 ESC/EAS guidelines for ASCVD prevention.
- Focus on the clinical benefits of treating the underlying causes of ASCVD.
Main Results:
- Maximum LDL-C reduction is recommended for ASCVD prevention, especially in high-risk individuals.
- Very low LDL-C levels are considered safe and offer further preventive benefits.
- Combination therapies (statins, ezetimibe, PCSK9 inhibitors) are increasingly important for high-risk patients.
Conclusions:
- The 2019 ESC/EAS guidelines advocate for aggressive LDL-C lowering to prevent ASCVD.
- A strategy focused on maximizing clinical benefit by treating lipid-related causes of ASCVD is emphasized.
- Combination therapies are crucial for achieving optimal LDL-C reduction in high-risk populations.
Abstract:
It has been well established that low-density lipoproteins (LDL) and other apolipoprotein B-containing lipoproteins are causally related to atherosclerotic cardiovascular disease (ASCVD) and that lowering these lipoproteins reduces the risk of ASCVD. By lowering LDL particles as much as possible, ASCVD can be prevented. There seems to be no LDL-cholesterol (LDL-C) threshold below which no further ASCVD prevention can be achieved. Furthermore, a low (an even very low) LDL-C appears to be safe. The new ESC/EAS guidelines based on these concepts are a step towards a benefit-based strategy by focusing on the clinical benefit that can be achieved by treating the cause of ASCVD. It is recommended to lower LDL-C as much as possible to prevent ASCVD, especially in high and very high-risk patients. With these new recommendations come recognition of the importance of combination therapies in high and very high-risk patients, first with statins and ezetimibe, and if needed with a PCSK9 inhibitor. The present paper is a review of some new concepts arising during the past 10 years in the field of lipidology and the description of what is new in the 2019 EAS/ESC guidelines.
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