News
UK NICE approves use of inclisiran: a gamechanger for patients and the NHS
The siRNA inclisiran is approved by the UK National Institute for Health and Care Excellence (NICE) for use in primary care in England. Inclisiran (Leqvio®), given as a twice-yearly injection, is recommended for people with primary hypercholesterolaemia or mixed dyslipidaemia who have had a previous…
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HUYGENS reinforces the importance of intensive lipid lowering after ACS
News from ESC Congress 2021 (Virtual). Lowering LDL cholesterol indisputably reduces cardiovascular events (1). The landmark PCSK9 inhibitor trials demonstrated that incremental lowering of LDL cholesterol against a background of intense statin therapy further reduced cardiovascular events, with no apparent threshold for clinical benefit from…
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No effect on cognitive function with alirocumab
Treatment with alirocumab for up to 96 weeks had no affect on cognitive function, assessed using the CANTAB (Cambridge Neuropsychological Test Automated Battery) scale, in this study of over 2,000 patients at increased cardiovascular risk (1). PCSK9 monoclonal antibody therapy is highly efficacious in lowering…
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More from FOURIER: Evolocumab effective in Asian patients
A new analysis from the FOURIER (Further Cardiovascular OUtcomes Research With PCSK9 Inhibition in Subjects with Elevated Risk) trial showed that evolocumab was equally effective in lowering the risk of cardiovascular events in Asian and non-Asian patients (1). FOURIER demonstrated that lowering LDL cholesterol levels…
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Are very low lipoprotein(a) levels safe? Insights from the Copenhagen General Population Study
High lipoprotein(a) levels are clearly established as a risk factor for cardiovascular disease and aortic valve stenosis (1,2). Recent lipid guidelines have affirmed the importance of measuring lipoprotein(a) [Lp(a)] in individuals with intermediate risk or with a family or personal history of premature or recurrent…
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Which lipid markers best identify residual risk in statin-treated patients?
LDL cholesterol is undoubtedly the priority lipid target to prevent atherosclerotic cardiovascular disease. Yet even with attainment of very low levels, high risk patients continue to experience cardiovascular events. The question is: which is the best lipid to target this residual risk? The options include…
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Treating high risk cardiovascular disease: Is combination lipid lowering therapy now the rule not the exception?
In 2019 the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) updated their guidelines for the management of dyslipidaemia to prevent atherosclerotic cardiovascular disease (ASCVD). On the basis of evidence from IMPROVE-IT with ezetimibe and the two landmark PCSK9 inhibitor trials, FOURIER with…
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HUYGENS: How does PCSK9 inhibition impact plaque phenotype?
Randomized controlled trials have unequivocally established that lowering levels of low-density lipoprotein (LDL) cholesterol reduces cardiovascular event rates in both the primary and secondary prevention setting (1). Moreover, there is no apparent threshold to benefit, as demonstrated in landmark cardiovascular outcomes studies with PCSK9 monoclonal…
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Pooled analysis highlights the promise of inclisiran
A new pooled analysis shows that inclisiran, twice yearly in addition to statin, is effective and safe in patients with or at high risk of atherosclerotic cardiovascular disease (ASCVD) (1). Low-density lipoprotein (LDL) cholesterol is established as causal for ASCVD (2,3). While statins are undoubtedly…
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News from ODYSSEY OUTCOMES: Lipoprotein(a) and diabetes risk
A new analysis from the ODYSSEY OUTCOMES study reports that lower lipoprotein(a) concentration is associated with increased risk for incident type 2 diabetes in patients with acute coronary syndrome (1). Beyond efficacious LDL cholesterol lowering, PCSK9 inhibitors also reduce lipoprotein(a) [Lp(a)], a highly heritable risk…
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EUROASPIRE: Need to improve risk factor management in women with diabetes and CAD
More needs to be done to improve risk factor management in women with dysglycaemia and coronary artery disease (CAD), according to findings from this survey within the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE) IV and V framework (1)….
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LDL cholesterol management inferior in women in primary care
In both primary and secondary prevention settings, management of LDL cholesterol is worse in women than men, according to this Swiss study in over 50,000 patients. It is well recognised that there are disparities between men and women in cardiovascular disease (CVD) prevention. While premenopausal…
read more »PCSK9 inhibitors and cognition back in the news
PCSK9 inhibitors and cognition back in the news Two recent reports have again raised the question of a possible link between the long-term effects of PCSK9 inhibition and cognitive adverse effects. In the first report from the UK BioBank (1), the association of genetic variants…
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Early and low for LDL cholesterol management post-MI
Early and low for LDL cholesterol management post-MI Patients with the earliest and largest LDL cholesterol reductions after myocardial infarction (MI) gain the most cardiovascular benefit, according to real-world data from a Swedish registry (1). Although clinical trials clearly show the cardiovascular benefits of targeting…
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ODYSSEY OUTCOMES: Uncertainty persists about CV benefit at LDL cholesterol <25 mg/dL
ODYSSEY OUTCOMES: Uncertainty persists about CV benefit at LDL cholesterol <25 mg/dL This latest analysis from the ODYSSEY OUTCOMES Investigators sought to resolve uncertainty regarding additional cardiovascular benefit at very low LDL cholesterol levels. Recent guidelines have lowered LDL cholesterol goals in very high-risk patients,…
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Early discontinuation of PCSK9 inhibitors problematic in practice
Over one-quarter of patients prescribed a PCSK9 inhibitor stop treatment within 6 months, according to this analysis of real-world practice. Landmark clinical trials – FOURIER with evolocumab and ODYSSEY OUTCOMES with alirocumab – have confirmed the benefit of PCSK9 inhibition, against a background of statin…
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Higher PCSK9 levels in patients with peripheral artery disease
Results from the CAVASIC study indicate that higher PCSK9 levels associate with peripheral artery disease (PAD), independent of other lipid variables or cardiovascular risk factors. The CAVASIC (CArdioVAScular disease in patients with Intermittent Claudication) Study was initiated in Austria in 2002 to identify cardiovascular risk…
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New Cochrane analysis reaffirms role for PCSK9 inhibitors
A new analysis including data on more than 60,000 patients reaffirms guideline recommendations for the use of PCSK9 monoclonal antibody therapy in high and very high-risk patients needing additional LDL cholesterol reduction to attain goals. This latest Cochrane analysis addressed a key question: What is…
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New guidance for familial hypercholesterolaemia care in Australia
The FH Australasia Network Consensus Working Group has published new evidence-informed guidance to improve the care of familial hypercholesterolaemia (FH, inherited high cholesterol) in the Australasia region. Driving this update to the 2011 guidance is the tsunami of publications about FH (1), as well as…
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News from South Africa: The Wits FIND-FH Program
This report discusses this phenotypic cascade screening program, much needed in South Africa. Familial hypercholesterolaemia (FH, inherited high cholesterol) is one of the commonest inherited diseases in the world, affecting about one in 250 to 300 of White populations (1). However, some countries such as…
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