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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
5 days ago
Elderly adults using hypoglycaemic glucose-lowering drugs, such as insulin and glinides, have an excess risk of hospitalization for serious trauma, a recent study has found.
Pearl Toh, 6 days ago

The duration of dual antiplatelet therapy (DAPT) should be individualized based on ischaemic and bleeding risk of a particular patient, rather than focusing on a dualistic short- vs long-duration therapy thinking, advocates a leading expert during AFCC 2018.

07 Oct 2018
Patients using long-acting opioids with immunosuppressive properties are at greater risk of developing serious infections compared with those using the nonimmunosuppressive opioid counterpart, according to a study.
5 days ago
Rather than the presence or type or urinary incontinence, increasing severity of urinary incontinence correlates with increased depression, anxiety and stress among treatment-seeking women with lower urinary tract symptoms (LUTS), suggests a study.