Author, as appears in the article.: Packard, Chris; Chapman, M. John; Sibartie, Mahendra; Laufs, Ulrich; Masana, Luis;

Department: Medicina i Cirurgia

URV's Author/s: Masana Marín, Luis

Keywords: Statin therapy Risk Pcsk9 Management Low ldl Long-term safety Hyperlipidaemias Hypercholesterolemia Evolocumab Esc/eas guidelines Epidemiology Efficacy Atherosclerosis

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.

Thematic Areas: Saúde coletiva Nutrição Medicina iii Medicina ii Medicina i General medicine Ciências biológicas ii Cardiology and cardiovascular medicine Cardiac & cardiovascular systems

licence for use: https://creativecommons.org/licenses/by/3.0/es/

Author's mail: luis.masana@urv.cat

Author identifier: 0000-0002-0789-4954

Record's date: 2023-02-19

Papper version: info:eu-repo/semantics/publishedVersion

Link to the original source: https://heart.bmj.com/content/107/17/1369.long

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: Heart. 107 (17): 1369-1375

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

Article's DOI: 10.1136/heartjnl-2020-318760

Entity: Universitat Rovira i Virgili

Journal publication year: 2021

Publication Type: Journal Publications