From the Editors
Targeting PCSK9 inhibitors to the right patient
Professor Stephen J Nicholls MBBS PhD, Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia The clinical development of pharmacological inhibitors of proprotein convertase subtilisin kexin type 9 (PCSK9) has received considerable attention by virtue of the expectation that these treatments would have the potential to…
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LDL cholesterol goals in patients with diabetes – How low?
Professor Derick Raal, University of the Witwatersrand, Johannesburg, South Africa. Patients with diabetes and a history of acute coronary syndrome (ACS) are at enhanced risk of recurrent events and death compared with those without diabetes.1 Does this mean that treatment with a PCSK9 inhibitor will…
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Surfing the PCSK9 wave of discovery
Prof Derick Raal (University of Witwatersrand, Johannesburg, South Africa) gives his perspective on the newest ‘PCSK9 kids on the block’ amidst the wave of PCSK9 discovery. In 2012, there was the first clinical evidence of dramatic reductions in LDL cholesterol by inhibiting PCSK9 with monoclonal…
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Did someone say “Beyond LDL-cholesterol”?
PCSK9 Forum Editor Professor John Chapman (Pitié-Salpétrière University Hospital, and Sorbonne University, Paris, France) discusses how ‘OMICS’ technologies could provide a precision medicine approach to managing non-LDL lipids. As a causal factor in atherosclerotic cardiovascular disease (ASCVD), measurement of LDL cholesterol has facilitated enormous progress…
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Coronary artery calcium in familial hypercholesterolaemia
Coronary artery calcium (CAC) score may have a role in stratifying short-term risk in patients with familial hypercholesterolaemia (FH, inherited high cholesterol), according to a new study. The authors suggest that this noninvasive approach may have value in targeting treatment with a PCSK9 inhibitor to…
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Stratifying risk in familial hypercholesterolaemia: does coronary artery calcium have a role?
PCSK9 Forum Editors Professor Gerald Watts (University of Western Australia, Perth, Australia) and Professor Derick Raal (University of the Witwatersrand, Johannesburg, South Africa) give their view. As a result of life-long exposure to high LDL cholesterol levels, individuals with familial hypercholesterolaemia (FH, inherited high cholesterol)…
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New US Cholesterol Guidelines: The good, the bad and the ugly
PCSK9 Forum Editor Professor Henry Ginsberg, Columbia University, New York, USA. The new guidelines might be viewed as a remake of the great spaghetti western called “The Good, the Bad, and the Ugly.” The Good includes recommendations for personalized discussions with patients that address short-…
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A new genetic mechanism for familial hypercholesterolaemia: PCSK9 whole gene duplication
Prof Robert A. Hegele, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Familial hypercholesterolemia (FH, inherited high cholesterol) patients continue to teach us new things about lipid metabolism. A case in point is our recent report of two Canadian…
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Is LDL-apheresis still needed in the PCSK9 era?
Dr Peter Lansberg, University Medical Center Groningen, The Netherlands With the successful introduction of PCSK9 monoclonal antibodies, patients are now able to dramatically reduce severely elevated LDL-cholesterol levels by up to 80-90%, when combined with statins and ezetimibe [1]. The recently published TAUSSIG study showed…
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The lipoprotein(a) – LDL cholesterol conundrum
Prof Derick Raal, University of the Witwatersrand, Johannesburg, South Africa The last decade has seen a resurgence of interest in lipoprotein(a) [Lp(a)], the mysterious brother of LDL (low-density lipoprotein). Indeed, there is now established evidence that Lp(a) is an independent risk factor for cardiovascular disease…
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Lipoprotein(a) – does it matter when LDL cholesterol is low?
Lipoprotein(a) is now recognised as an independent risk factor for cardiovascular disease. But is it also relevant to consider lipoprotein(a) when LDL cholesterol is low? Prof. Anthony S Wierzbicki, Guy’s and St Thomas’ Hospitals, London, UK discusses the evidence. Lipoprotein(a) [Lp(a)] is a well-characterised biomarker…
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PCSK9 Monoclonal Antibody Therapy in Patients with Diabetes: Where We Are and Future Needs
Patients with type 2 diabetes are at increased risk of cardiovascular disease events, especially if pre-existing atherosclerotic cardiovascular disease (ASCVD) is present. Indeed, recent guidelines from the American Association of Clinical Endocrinologists (AACE) have classified these patients as being at “extreme risk” and thus requiring…
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PSCK9 inhibitor therapy- after the clinical trials, what can we learn to improve practice?
The major cardiovascular disease (CVD) outcomes trials with the antibody-based inhibitors of proprotein convertase subtilisin kexin type 9 (PCSK9) have now been completed. Both ODYSSEY Outcomes with alirocumab in patients with acute coronary syndromes (ACS) and FOURIER with evolocumab in patients with stable CVD, were…
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New Approaches to PCSK9 inhibition
Prof Derick Raal (University of Witwatersrand, Johannesburg, South Africa) discusses what’s in the pipeline for PCSK9 inhibition beyond the monoclonal antibodies. PCSK9 monoclonal antibodies Modulation of PCSK9 can result in much greater lowering of LDL-cholesterol than that achieved with statin therapy or statin therapy in…
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Paediatric FH: what do we still need to know?
FH is a common inherited hyperlipidaemia, characterized by elevated cholesterol levels from birth which, if untreated, lead to accelerated atherosclerosis and premature coronary artery disease in adulthood. Clearly, there is an urgent need to identify these individuals in childhood so as to instigate treatment as…
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Looking back at 2017 and forward to 2018
PCSK9 Forum Editor Professor Anthony Wierzbicki (St Thomas’ Hospital, London UK) discusses the key trials in cardiovascular disease prevention in 2017 and what 2018 offers.
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Evolocumab in lower extremity peripheral artery disease
Lower extremity peripheral artery disease (LEPAD) is associated with an elevated risk of atherosclerotic cardiovascular disease (ASCVD) and mortality1. Classically, risk factors for LEPAD are heavy smoking, diabetes and older age, although dyslipidaemia also predisposes to LEPAD, as shown by a recent study2. Furthermore, Pereira…
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Depression, Cardiovascular Disease and Adherence
David Hare & Samia R Toukhsati, University of Melbourne, Australia This editorial discusses the interrelationship between cardiovascular disease and depression and poses the question: Is depression a key modulator of patient adherence and clinical outcome? “Depression” can refer to anything from feeling transiently unhappy through…
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ESC/EAS Task Force issues updated clinical guidance for PCSK9 inhibitors
This Task Force from the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) has considered new evidence from cardiovascular outcomes studies with evolocumab (FOURIER) and bococizumab (now terminated), new analyses and genetic studies.t Taking account of the cost of these agents, the Task…
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REVEAL Study. Should we welcome a new lipid lowering drug family?
The significant and positive results obtained by REVEAL (Randomized EValuation of the Effects of Anacetrapib Through Lipid-modification study) (1) are good news. These data show that we have a new lipid modifying drug, that by significantly reducing atherogenic non-high-density lipoprotein (HDL) cholesterol, decreases major cardiovascular…
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