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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, 29 Jun 2020
Having migraine during midlife appears to be associated with a higher risk of developing dementia in later life, according to a large population-based longitudinal Danish study presented at the AHS* 2020 Virtual Meeting, indicating that migraine may be a risk factor for dementia.
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Patients with psoriatic arthritis (PsA) often suffer from liver abnormalities, which are associated with higher body mass index (BMI), daily consumption of alcohol, more severe disease, and some therapies, according to a recent study.
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Pembrolizumab in combination with chemotherapy significantly improves progression-free survival (PFS) vs chemotherapy alone in patients with previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC), results of the KEYNOTE-355 study have shown.

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