Hot topics

Stroke risk in heterozygous FH

Are individuals with heterozygous familial hypercholesterolaemia (FH, inherited high cholesterol) at higher risk of stroke? And if so, does statin treatment ameliorate this risk? Results from this meta-analysis suggest this may be the case. Heterozygous FH is undoubtedly associated with an increased risk of premature…

ATVB Council statement on nonstatin LDL therapy

This timely statement, led by Professor Robert Hegele, Robarts Research Institute, Western University, London, Ontario, Canada, considers the place of nonstatin therapy, including PCSK9 inhibitors, in the prevention of cardiovascular disease (CVD). Evidence conclusively establishes LDL cholesterol as causal for atherosclerosis and CVD. Statins are…

Universal screening for FH in children

A report from Slovenia makes the case for universal screening for familial hypercholesterolaemia (FH, inherited high cholesterol) incorporating both family history and genetic data. Total cholesterol (TC) was measured in all children at age 5 years as part of the Slovenia national universal screening for…

PCSK9 inhibition and glucose homeostasis: new reassurance from human genetics

INSERM, UMR1087-CNRS UMR6291 & Université de Nantes, Faculté de Médecine, l’Institut du Thorax, and Department of Endocrinology, University Hospital of Nantes, Nantes, France The role of PCSK9 in glucose homeostasis is a critical issue, especially for the PCSK9 inhibitors (1), which are likely to be…

LDL cholesterol lowering, PCSK9 and neurocognitive effects?

The possibility of neurocognitive effects with low-density lipoprotein (LDL) cholesterol lowering has been much debated. A new study (1) raises this issue again, suggesting increased risk of memory loss during the 30 days following the start of treatment, when comparing statin users and nonusers of…

Making premature CHD history

Dr Samuel Gidding discusses how treating children with FH early can make premature CHD history

How to identify children with FH

Dr Samuel Gidding discusses how to identify children with FH

Safety of lowering LDL-C

Dr Albert Wiegman discusses the safety of lowering LDL C in FH children

EAS Consensus Panel on Paediatric FH

Dr Raul Santos discusses the EAS Consensus Panel statement on FH in children – Spanish Dr Raul Santos discusses the EAS Consensus Panel statement on FH in children – Portuguese

Statin Associated Muscle Symptoms – a role for PCSK9 inhibitors? Professor Erik Stroes, Academic Medical Center, Amsterdam, the Netherlands comments

The latest European Atherosclerosis Society Consensus Panel focused on statin associated muscle symptoms (SAMS),1 which at present accounts for up to 40% of referrals to specialised lipid clinics. The veracity of SAMS has been questioned given the apparent discrepancy between findings from clinical trials and…

Statins and muscle symptoms: New EAS Consensus Panel statement

The European Atherosclerosis Society (EAS) Consensus Panel has published new guidance on the diagnosis, assessment and treatment of statin-associated muscle symptoms (SAMS). Unique to this statement is an overview of current understanding of the pathophysiology of statin myopathy. Without doubt, statins are the therapeutic cornerstone…

Lifetime exposure and primordial prevention

Atherosclerosis is a slow onset insidious disease. It is asymptomatic until its manifestations cause significant morbidity and mortality. There is no cheap easy way to detect it. As a result disease management strategies rely on epidemiologically-based risk calculators to identify individuals likely to have significant…

IMPROVE-IT: Trial data follow through on genetics

An ATVB editorial implies that results from IMPROVE-IT could have been predicted by considering genetics data. In a previous report from the Myocardial Infarction Genetics Consortium Investigators,1 carriage of inactivating mutations that attenuate Niemann-Pick C1-like 1 (NPC1L1) function reduced both LDL cholesterol and also protected…

Enhancing and Improving cardiovascular outcomes

Implications from IMPROVE-IT: Perspective from Anthony S. Wierzbicki* The link between low density lipoprotein-cholesterol (LDL-C) and cardiovascular disease (CVD) is well established 1 2 . Statins are the first-line drug therapy for the treatment of lipid-associated CVD risk. However the role of second line therapies…

Latest IMPROVE-IT commentary

How low should LDL-C be lowered? Thoughts of IMPROVE-IT rekindle debate

LDL-C: how low should clinicians aim for?

Trials with monoclonal antibodies – PCSK9 inhibitors – will answer the question of how far should low density lipoprotein cholesterol (LDL-C) be reduced?

Lowering LDL-C: How low and for how long?

Treatment to reduce low density lipoprotein cholesterol (LDL-C) should be started in teenage years in people with very high risk of cardiovascular death or events e.g. heart attacks. There is substantial evidence showing significant benefits if LDL-C is reduced by about 50%, Professor Evan Stein…

Lowering LDL-C : at what level would this impact the benefit vs. risk ratio?

Emeritus Research Professor, Institut de recherches cliniques de Montréal (IRCM), Canada Potent inhibitors of pro-protein convertase-subtilisin-kexin-9 (PCSK9) have the capacity to reduce plasma low-density lipoprotein cholesterol (LDL-C) to unprecedentedly low levels, especially if combined with statins. This discovery raises several important questions; how low should…

IMPROVE-IT: will it prove anything?

Professor Anthony S. Wierzbicki, London UK Comments on the IMPROVE-IT debate Cardiovascular disease (CVD) guidelines are emphasising the use of clinical outcome data on major vascular events (American Heart Association/American College of Cardiology)1 or hard CVD events alone (UK NICE)2 . They have begun to…