Most Read Articles
3 days ago
The appropriate cutoff value in predicting combined cardiovascular outcomes in patients with type 2 diabetes (T2D) is 125 mm Hg for home morning systolic blood pressure (MSBP), suggests a new study.
06 Apr 2018

Female patients with coronary artery disease (CAD) have greater regression of coronary atherosclerosis than male patients despite a lower plaque burden at baseline, data from the GLAGOV trial have shown.

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Transcatheter aortic valve replacement (TAVR) in severe symptomatic aortic stenosis (AS) patients is superior to conventional surgical aortic valve replacement (SAVR) in terms of reducing life-threatening bleeding, new-onset atrial fibrillation and acute kidney injury, a recent meta-analysis has found.
Pearl Toh, 2 days ago
Whether the 2017 ACC/AHA* blood pressure (BP) guidelines should be adopted in Asian countries was the topic of a much-anticipated discussion here at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taiwan last week.

LDL-C is the cardinal modifiable predictor of atherosclerosis in the absence of risk factors

15 May 2018

A study by researchers at Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) found that, even at levels currently considered normal, low-density lipoprotein cholesterol (LDL-C) is a prime predictor of the presence of atherosclerotic plaques in arteries. [J Am Coll Cardiol 2017;70:2979–2991] These findings provide a basis to the occurrence of myocardial infarction in healthy individuals with no cardiovascular (CV) risk factors, ie, hypertension, smoking, obesity, dyslipidaemia and diabetes.

 

Fortunately, this new-found independent risk factor can be modified to prevent the development of atherosclerotic plaques, thus emphasizing the need for aggressive LDL-C reduction strategies, even in individuals with no CV risk factors. The research team noted the importance of defining new CV risk factors in addition to those currently known, as a measure towards early detection and prevention of CV events. “Although the absence of classical CV risk factors is linked to low risk of CV events, people in this situation still have heart attacks and strokes. We therefore need to define new markers of early atherosclerosis in these apparently healthy individuals,” said the study’s first author, Dr Leticia Fernández-Friera.

 

Atherosclerotic CV diseases are the leading cause of morbidity and mortality, worldwide. Though associated with multiple risk factors, LDL-C (ie, ‘bad’ cholesterol) is directly implicated in the development of atherosclerotic CV diseases. [Eur Heart J 2017;38:2459–2472] The evaluation of a subgroup of participants with no classical CV risk factors, from the Progression of Early Subclinical Atherosclerosis (PESA) study, reported that apart from age and the male sex, LDL-C is prominently associated with the presence of atherosclerotic plaques. [J Am Coll Cardiol 2017;70:2979–2991] According to Dr Javier Sanz, who was part of the research team, “even in people with optimal blood pressure, blood sugar, and total cholesterol, we detected an independent association between the level of circulating LDL-C and the presence and extent of subclinical atherosclerosis”. With the aid of the latest noninvasive vascular imaging technology, the researchers demonstrated the presence of atherosclerotic plaques in 49.7% of middle-aged individuals without CV risk factors.

 

The findings of this study could pave the way towards defining new normal levels of LDL-C, one that is much lower than those stated in current guidelines. “We should be more restrictive, and consider lowering the threshold values stipulated in the guidelines,” stressed the researchers. The findings of this study serve to guide primordial prevention and better understand the pathology underlying early atherosclerosis. The ability to identify patients with the disease prior to the appearance of symptoms could help avoid or reduce disease-related complications, translating into enormous societal and economic benefits.

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Most Read Articles
3 days ago
The appropriate cutoff value in predicting combined cardiovascular outcomes in patients with type 2 diabetes (T2D) is 125 mm Hg for home morning systolic blood pressure (MSBP), suggests a new study.
06 Apr 2018

Female patients with coronary artery disease (CAD) have greater regression of coronary atherosclerosis than male patients despite a lower plaque burden at baseline, data from the GLAGOV trial have shown.

26 Apr 2018
Transcatheter aortic valve replacement (TAVR) in severe symptomatic aortic stenosis (AS) patients is superior to conventional surgical aortic valve replacement (SAVR) in terms of reducing life-threatening bleeding, new-onset atrial fibrillation and acute kidney injury, a recent meta-analysis has found.
Pearl Toh, 2 days ago
Whether the 2017 ACC/AHA* blood pressure (BP) guidelines should be adopted in Asian countries was the topic of a much-anticipated discussion here at the Asian Pacific Society of Cardiology (APSC) Congress 2018 in Taiwan last week.