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Future directions in CVD prevention

10 Oct 2018

A comprehensive approach involving a combination of LDL-cholesterol (LDL-C) lowering and anti-inflammatory therapy may improve clinical outcomes for appropriately selected patients at risk of cardiovascular disease (CVD), according to Dr San-Hyun Kim of the Seoul National University in Korea.

“LDL-C is the primary target of treatment, and studies have shown that the lower the level, the greater the risk reduction,” said Kim. [N Engl J Med 2004;3501495-1504; N Engl J Med 2005;352:1425-1435] “While statins are the drugs of choice for dyslipidaemia management, non-statin therapies are safe and effective when added to statin therapy.”

Adding ezetimibe has achieved incremental LDL-C lowering with better clinical prognosis. [N Engl J Med 2015;372:2387-2397] More recently, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have demonstrated significant 60 percent reductions in LDL-C with about 15 percent reductions in major adverse cardiovascular events (MACE) in patients already on statin therapy. [N Engl J Med 2017;376:1713-1722; Steg PG, et al, ACC 2018]

“Targeting the inflammatory interleukin pathway offers additional atheroprotection, independent of lipid lowering,” he argued. “For example, canakinumab, which targets interleukin-1b, has shown a 15 percent reduction in MACE. This has been attributed to significant 35–40 percent reductions in high sensitivity C-reactive protein [hsCRP] and interleukin-6, without any change in LDL-C.” [N Engl J Med 2017;377:1119-1131]

Kim emphasized that appropriate therapy selection based on patients’ underlying risk factors is crucial for successful atheroprotection and CVD risk reduction.

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Most Read Articles
Pearl Toh, 15 Jul 2019
In addition to the known evils of maternal smoking during pregnancy on the son’s semen quality, prenatal exposure to paternal smoking can also be harmful, according to data from the large Danish National Birth Cohort (DNBC) presented at the ESHRE 2019 Meeting.
15 Jul 2019
Fluticasone, swallowed from a multidose inhaler, and oral viscous budesonide slurry have comparable efficacies as initial treatment for eosinophilic oesophagitis, a recent study has found.
2 days ago
Health-related quality of life (HRQoL) among patients with kidney stone is worse in those who are young and female than those who are older and male, according to a recent study. Non-Caucasian patients also have a lower HRQoL.
Tristan Manalac, 3 days ago
In patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI), admission Killip classification and creatinine and troponin levels are important cardiac mortality predictors, according to a recent Singapore study.