News
No link between low LDL-C and dementia
Results from this Mendelian randomisation study do not show any association between exposure to low LDL cholesterol levels and risk of dementia. The study used a number of genetic variants known to be involved with LDL cholesterol synthesis and metabolism: hydroxy-3-methylglutaryl-CoA reductase (HMGCR); rs17238484, and…
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Evolocumab: Higher doses, less variability in LDL response
The approval of the PCSK9 monoclonal antibodies offers a novel approach to addressing unmet clinical needs in high cardiovascular risk patients. However, because evolocumab is offered as either 2-weekly or monthly dose regimens further information is needed so clinicians can make the right decision regarding…
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Hope for a small molecule PCSK9 inhibitor?
Current developments aimed at targeting PCSK9 have predominantly focused on monoclonal antibody therapies, or latterly on inhibiting synthesis of this protein with RNA interference approaches. However, is there a possibility for a small molecule antagonist of PCSK9? Results from this experimental study suggests potential in…
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ODYSSEY trials analysis: Alirocumab 75 mg 2-weekly adequate in most patients
One question from the phase III trials with the PCSK9 monoclonal antibody alirocumab is how many high cardiovascular risk patients require uptitration. Results from an analysis of more than 1200 patients included in 6 Phase III trials from the ODYSSEY programme show that most attained…
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Benefit of alirocumab in moderate chronic kidney disease
Patients with chronic kidney disease (CKD) represent an important high cardiovascular risk group, especially in view of evidence that the prevalence of this condition is increasing rapidly world-wide. Statins with minimal renal excretion are the treatment of choice for management of the associated dyslipidaemia; however,…
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Need to manage lipoprotein(a), blood pressure and renal insufficiency in familial hypercholesterolaemia
This study makes the case for identifying and managing elevated lipoprotein(a), high blood pressure, and renal insufficiency, to reduce the risk of premature coronary artery disease (CAD) in patients with familial hypercholesterolaemia (FH, inherited high cholesterol). Elevated lipoprotein(a) [Lp(a)] is already recognised as causal for…
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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…
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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…
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European Union targets familial hypercholesterolemia (FH, inherited high cholesterol)
Patient groups representing up to 4.5 million Europeans with genetic high cholesterol joined MEPs and cardiologists at the European Parliament to raise awareness of Familial Hypercholesterolemia (FH), calling for improved diagnosis, care and management of this life-threatening and under-diagnosed disease which contributes to the annual €196…
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Underutilization of cascade screening for familial hypercholesterolemia
Why cascade screening for familial hypercholesterolemia. Cascade screening in the context of dyslip- idemia refers to cholesterol testing of close relatives of individuals who fulfill genetic or phenotypic criteria for the diagnosis of famil- ial hypercholesterolemia (FH).
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HoFH in the Middle East: Consensus paper
A Consensus Panel from experts in the Middle East, including representation from Oman, Saudi Arabia, United Arab Emirates, Iran and Bahrain, has highlighted issues specific to this region that complicate the diagnosis and management of familial hypercholeterolaemia (FH, inherited high cholesterol). In particular, the epidemic…
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Alirocumab in PCSK9 Gain of Function hypercholesterolaemia
The PCSK9 monoclonal antibody alirocumab is effective and well tolerated in patients with autosomal dominant hypercholesterolaemia caused by PCSK9 gain of function (GOF) mutations. This is the first study indicating the benefit of PCSK9 inhibition in these individuals with a rare but severe hypercholesterolaemia due…
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Missed opportunities for FH detection
Consistent with findings previously reported from the EUROASPIRE IV study (1), this report from Australia also highlighted a high prevalence of likely FH in patients aged less than 60 years admitted to the coronary care unit. In 175 coronary care patients aged less 60 years, about…
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PCSK9 predominant influence on FH phenotype
PCSK9 is an important determinant of the severity of heterozygous familial hypercholesterolaemia (FH, inherited high cholesterol), independent of the functionality of the LDLR mutation, according to this study. LDLR mutations are the predominant type of FH-causing mutation identified on genetic testing. Whether the nature of…
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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…
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IMPROVE-IT: no increased diabetes risk with ezetimibe-statin
A subgroup analysis from IMPROVE-IT showed that there was no excess risk of new-onset diabetes in patients treated with the combination of simvastatin plus ezetimibe. Data were presented by Dr Michael Blazing, Duke University, Durham, USA. The findings provide reassurance after a recent report questioned…
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Statin intolerance: International study
An international survey involving 13 countries in Europe, South America, Asia-Pacific and the USA reinforce recent consensus that statin intolerance is an issue in up to 12% of patients. Importantly, about 10% of these patients receive no lipid lowering therapy after discontinuation of statin. While…
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Sustained lowering of Lp(a) with alirocumab in 4915 patients
In this pooled analysis of 10 clinical trials in the ODYSSEY Clinical trial programme, alirocumab (75/150 mg every 2 weeks) resulted in sustained lowering of lipoprotein(a) [Lp(a)] by 23-29%. In all except two trials (ODYSSEY ALTERNATIVE and ODYSSEY MONO) patients were on background statin therapy….
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PROFICIO: more evolocumab data
Long-term follow-up of GAUSS patients: durable, well tolerated response to evolocumab In statin-intolerant patients who completed GAUSS-1 and GAUSS-2, evolocumab showed sustained LDL cholesterol lowering over a median 11 month follow-up, with no increase in myalgia, compared with the standard of care. This report pooled…
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ODYSSEY 78-week data in heterozygous FH: PCSK9 FORUM Expert view
ESC Congress 2015, 1 September 2015 Familial hypercholesterolaemia (FH, inherited high cholesterol) represents one of the key priorities for PCSK9 monoclonal antibody therapy. This analysis from the ODYSSEY clinical programme with alirocumab, which has the largest group of heterozygous FH patients studied to date, establishes…
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