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Assessing Whole-Body Lipid-Handling Capacity in Mice
Published on: November 24, 2020
[UPDATED ISRAELI GUIDELINES FOR THE TREATMENT OF DYSLIPIDEMIA 2020]
Hofit Cohen1,2, Ronen Durst3, Ophir Avizohar4
1The Bert W. Strassburger Lipid Center, The Chaim Sheba Medical Center, Tel-Hashomer , Israel.
Insights
New guidelines recommend lower LDL cholesterol targets for atherosclerotic cardiovascular diseases (ASCVD) treatment. Combining statins with newer drugs like PCSK9 inhibitors offers additional benefits for managing dyslipidemia and reducing ASCVD risk.
Area of Science:
- Cardiology
- Atherosclerosis Research
- Lipid Metabolism
Background:
- Atherosclerotic cardiovascular diseases (ASCVD) remain a major global health concern despite declining mortality rates.
- Low-density lipoprotein (LDL) cholesterol is a key factor in atherosclerosis development.
- Previous guidelines focused on statins for dyslipidemia, but newer therapies offer additional benefits.
Purpose of the Study:
- To update guidelines for ASCVD prevention and treatment based on recent evidence.
- To provide recommendations for risk stratification, target LDL cholesterol goals, and treatment strategies.
- To incorporate newer LDL-lowering therapies into clinical practice.
Main Methods:
- Formulation of updated guidelines by a multidisciplinary committee of Israeli medical societies.
- Review of recent studies on LDL cholesterol-lowering drugs (statins, ezetimibe, PCSK9 inhibitors).
- Analysis of evidence supporting lower LDL cholesterol targets and combination therapies.
Main Results:
- Lower LDL cholesterol targets provide additional ASCVD risk reduction without a discernible safety threshold.
- Combination therapies, including ezetimibe and PCSK9 inhibitors with statins, offer incremental benefits.
- Evidence supports the use of these newer agents in specific patient subgroups.
Conclusions:
- Updated guidelines emphasize more aggressive LDL cholesterol lowering for ASCVD prevention.
- Novel treatment strategies involving combination therapy are recommended.
- Revised risk stratification and target goals aim to improve patient outcomes in ASCVD.
Introduction:
Despite the impressive decline in mortality from atherosclerotic cardiovascular diseases (ASCVD), these diseases still account for a large proportion of the overall morbidity and mortality worldwide. A vast amount of research has demonstrated the key role played by circulating lipoproteins, and especially low-density lipoprotein (LDL), in the etiology of atherosclerosis, and numerous studies have proven the efficacy of interventions that lower the atherogenic lipoproteins in reducing morbidity and mortality from ASCVD. While previous guidelines placed an emphasis on the use HMG-CoA reductase inhibitors (statins) for the treatment of dyslipidemia, recent studies have shown that other LDL cholesterol lowering drugs, including ezetimibe and the PCSK9 inhibitors, can provide additional benefit when used in combination with (and in certain cases instead of) statins. These studies have also shown that blood LDL cholesterol levels lower than previously recommended targets provide additional benefit, without evidence of a threshold beyond which the benefit ceases and without excess adverse effects. The updated guidelines were formulated by a committee that consisted of representatives from the Israeli Society for the Research, Prevention and Treatment of Atherosclerosis, the Israel Society of Internal Medicine, the Israeli Heart Association, the Israeli Neurology Association and the Israel Association of Family Medicine. They provide recommendations for revised risk stratification of patients, novel target goals, and the use of evidence-based treatment and follow-up strategies with reference to specific patient sub-groups.
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