Articles producció científica> Medicina i Cirurgia

Intensive low-density lipoprotein cholesterol lowering in cardiovascular disease prevention: opportunities and challenges

  • Dades identificatives

    Identificador: imarina:9226475
    Autors:
    Packard, ChrisChapman, M. JohnSibartie, MahendraLaufs, UlrichMasana, Luis
    Resum:
    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.
  • Altres:

    Autor segons l'article: Packard, Chris; Chapman, M. John; Sibartie, Mahendra; Laufs, Ulrich; Masana, Luis;
    Departament: Medicina i Cirurgia
    Autor/s de la URV: Masana Marín, Luis
    Paraules clau: Statin therapy Risk Pcsk9 Management Low ldl Long-term safety Hyperlipidaemias Hypercholesterolemia Evolocumab Esc/eas guidelines Epidemiology Efficacy Atherosclerosis
    Resum: 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.
    Àrees temàtiques: Saúde coletiva Nutrição Medicina iii Medicina ii Medicina i General medicine Ciências biológicas ii Cardiology and cardiovascular medicine Cardiac & cardiovascular systems
    Accès a la llicència d'ús: https://creativecommons.org/licenses/by/3.0/es/
    Adreça de correu electrònic de l'autor: luis.masana@urv.cat
    Identificador de l'autor: 0000-0002-0789-4954
    Data d'alta del registre: 2024-07-27
    Versió de l'article dipositat: info:eu-repo/semantics/publishedVersion
    Enllaç font original: https://heart.bmj.com/content/107/17/1369.long
    URL Document de llicència: https://repositori.urv.cat/ca/proteccio-de-dades/
    Referència a l'article segons font original: Heart. 107 (17): 1369-1375
    Referència de l'ítem segons les normes APA: Packard, Chris; Chapman, M. John; Sibartie, Mahendra; Laufs, Ulrich; Masana, Luis; (2021). Intensive low-density lipoprotein cholesterol lowering in cardiovascular disease prevention: opportunities and challenges. Heart, 107(17), 1369-1375. DOI: 10.1136/heartjnl-2020-318760
    DOI de l'article: 10.1136/heartjnl-2020-318760
    Entitat: Universitat Rovira i Virgili
    Any de publicació de la revista: 2021
    Tipus de publicació: Journal Publications
  • Paraules clau:

    Cardiac & Cardiovascular Systems,Cardiology and Cardiovascular Medicine
    Statin therapy
    Risk
    Pcsk9
    Management
    Low ldl
    Long-term safety
    Hyperlipidaemias
    Hypercholesterolemia
    Evolocumab
    Esc/eas guidelines
    Epidemiology
    Efficacy
    Atherosclerosis
    Saúde coletiva
    Nutrição
    Medicina iii
    Medicina ii
    Medicina i
    General medicine
    Ciências biológicas ii
    Cardiology and cardiovascular medicine
    Cardiac & cardiovascular systems
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