Related Experiment Video
Updated: Nov 10, 2025
Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Intensive low-density lipoprotein cholesterol lowering in cardiovascular disease prevention: opportunities and
Chris Packard1, M John Chapman2, Mahendra Sibartie3
1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK Chris.Packard@glasgow.ac.uk.
Insights
Achieving very low low-density lipoprotein cholesterol (LDL-C) levels is recommended for high-risk patients. Combination therapies with statins, ezetimibe, and PCSK9 inhibitors safely reduce cardiovascular events.
Area of Science:
- Cardiology
- Atherosclerosis
- Lipidology
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) significantly increases coronary heart disease and stroke risk.
- Recent European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines (2019) emphasize aggressive LDL-C reduction.
- Innovative lipid-lowering agents combined with statins enable unprecedented LDL-C lowering.
Purpose of the Study:
- To review evidence supporting the ESC/EAS recommendation for markedly reduced LDL-C levels.
- To provide expert opinion on the clinical significance of aggressive LDL-C goals.
- To highlight the safety and efficacy of combination therapies for cardiovascular risk reduction.
Main Methods:
- Review of recent intervention trials involving novel lipid-lowering agents.
- Analysis of clinical trial data on combination therapy outcomes (statins, ezetimibe, PCSK9 inhibitors).
- Inclusion of genetic studies on lifelong very low LDL-C levels and cardiovascular risk.
Main Results:
- Combination therapies facilitate routine achievement of extremely low LDL-C levels.
- Profound LDL-C lowering significantly reduces cardiovascular events compared to moderate lowering, with no observed safety concerns over 5-7 years.
- Genetic studies confirm lifelong very low LDL-C is associated with reduced cardiovascular risk without detrimental health effects.
Conclusions:
- The 'lower is better' paradigm is supported by current evidence for high-risk individuals.
- Aggressive LDL-C reduction using combination therapy is a safe and effective strategy for preventing cardiovascular events.
- Long-term safety studies are warranted to further solidify the evidence base for sustained LDL-C lowering.
Abstract:
Elevated levels of low-density lipoprotein cholesterol (LDL-C) are associated with increased risk of coronary heart disease and stroke. Guidelines for the management of dyslipidaemia from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) were updated in late 2019 in light of recent intervention trials involving the use of innovative lipid-lowering agents in combination with statins. The new guidelines advocate achieving very low LDL-C levels in individuals at highest risk, within the paradigm of 'lower is better'. With the advent of combination therapy using ezetimibe and/or proprotein convertase subtilisin/kexin type 9 inhibitors in addition to statins, the routine attainment of extremely low LDL-C levels in the clinic has become a reality. Moreover, clinical trials in this setting have shown that, over the 5-7 years of treatment experience to date, profound LDL-C lowering leads to further reduction in cardiovascular events compared with more moderate lipid lowering, with no associated safety concerns. These reassuring findings are bolstered by genetic studies showing lifelong very low LDL-C levels (<1.4 mmol/L; <55 mg/dL) are associated with lower cardiovascular risk than in the general population, with no known detrimental health effects. Nevertheless, long-term safety studies are required to consolidate the present evidence base. This review summarises key data supporting the ESC/EAS recommendation to reduce markedly LDL-C levels, with aggressive goals for LDL-C in patients at highest risk, and provides expert opinion on its significance for clinical practice.
More Related Videos
07:29Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
08:45LDL Cholesterol Uptake Assay Using Live Cell Imaging Analysis with Cell Health Monitoring
Published on: November 17, 2018
Related Concept Videos
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:18Lipids: Dietary Sources and Requirements
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...