Dyslipidemia is the most common modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). There is unequivocal evidence that Low Density Lipoprotein Cholesterol (LDL-C) is the main culprit. Statins, ezetimibe, bempedoic acid and Proprotein Convertase Subtilisin/ Kexin Type 9 (PCSK9) inhibitors are used to target LDL-C. Statin is always utilized as the first line therapy and they decrease LDL-C by approximately 1 mmol/l (40 mg/dL). If the LDL goals are not achieved ezetimibe is used and this decreases LDL-C by 15-20%. Bempedoic acid can also be utilized to lower LDL-C before initiating PCSK9 inhibitors but this is not available in India as yet. PCSK9 inhibitors decrease LDL-C by 1 to 1.5 mmol/l (40-60 mg/dL) on top of all lipid lowering therapy and with this very low LDL-C level targets of < 55 or even < 40 mg/dL can be achieved in very high risk patient. After the LDL-C goal is achieved, non HDL-C is targeted if the triglycerides (TG) levels are above 200 mg/dL. Targeting HDL-C with drugs is not recommended because all trials of HDL-C elevating drugs on top of statins have been negative. The role of TG has a causal factor for ASCVD is still in the process of evolution. Icospent ethyl in REDUCE IT trial has shown reduction in ischemic cardiovascular events in patients with established CVD or diabetics with other risk factors on statins and elevated TG between 135-499 mg/dL. but the mechanism of benefit does not seem to be related to lowering of TG because the benefit was similar in subgroup of patients with TG > 150 <150 mg/dL. Inclisiran which blocks the synthesis of PCSK9 is emerging as very exciting molecule for the future. It decreases LDL-C by 50% which remains there for six months after a single injection of 300 mg.
| Published in |
American Journal of Internal Medicine (Volume 8, Issue 6)
This article belongs to the Special Issue Dyslipidemia: Flash Back and Vision Ahead |
| DOI | 10.11648/j.ajim.20200806.16 |
| Page(s) | 274-278 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2020. Published by Science Publishing Group |
LDL-C Main Culprit of ASCVD, Statins First Drug for Dyslipidemia, Proprotein Convertase Subtilsin-kexin Type 9
| [1] | Mach Francois, Baigent Colin, Catapano Alberico L, et. al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). EHJ. 2020; 41 (1): 111-188. |
| [2] | Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC Multisociety Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019; 73 (24): 3237-3241. |
| [3] | American Diabetes Association Standards of Medical Care in Diabetes 2020 Volume 43, Supplement 1. |
| [4] | SS Iyengar, Raman Puri, et al. Special issue on LAI Expert Consensus Statement on Management of Dyslipidemia in Indians 2016. JAPI Special issue 2016; 64: 7-52. |
| [5] | Christopher P. Cannon, Michael A. Blazing, Rober P. Giugliano, et al for the IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015; 372: 2387-97. |
| [6] | Marc S. Sabatine M C, Giugliano, Keech A C, et al. For the FOURIER Steering Committee and Investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017: 376: 1713-1722. |
| [7] | Schwartz Gregory G, Steg P Gabriel, Szarek Michael, et al., for the ODYSSEY OUTCOMES Committees and Investigators Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome N Engl J Med 2018; 379: 2097-2107. |
| [8] | Neef D, Berthold HK, Gouni-Berthold, et al. Lomitapide for use in patients with homozygous familial hypercholesterolemia: a narrative review. Expert Rev Clin Pharmacol. 2016; 9 (5): 655-63. |
| [9] | Stein EA, Dufour R, Gagne C, et al. Apolipoprotein B synthesis inhibition with mipomersen in heterozygous familial hypercholesterolemia: results of a randomized, double-blind, placebo-controlled trial to assess efficacy and safety as add-on therapy in patients with coronary artery disease. Circulation 2012 Nov. 6; 126: 2283-2292. |
| [10] | The ACCORD Study Group. Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 2010; vol. 362 (17): 1563-1574. |
| [11] | Lee M, Saver JL, Towfighi A, Chow J, Ovbiagele B, et al. Efficacy of fibrates for cardiovascular risk reduction in persons with atherogenic dyslipidemia: a meta-analysis. Atherosclerosis 2011 Aug; 217 (2): 492-8. |
| [12] | Bhatt Deepak L, Steg P. Gabriel, Miller Michael et al., for the REDUCE-IT Investigators Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia N Engl J Med 2019; 380: 11-22. |
| [13] | Ray K K, Landmesser Ulf, Leiter A L, et al. Inclisiran in patients at high cardiovascular risk with elevated LDL cholesterol. N Engl J med 2017; 376: 1430-1440. |
APA Style
Prabhash Chand Manoria, Pankaj Manoria, Rajesh Kumar Shrivastava, Sharad Kumar Parashar. (2020). Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead. American Journal of Internal Medicine, 8(6), 274-278. https://doi.org/10.11648/j.ajim.20200806.16
ACS Style
Prabhash Chand Manoria; Pankaj Manoria; Rajesh Kumar Shrivastava; Sharad Kumar Parashar. Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead. Am. J. Intern. Med. 2020, 8(6), 274-278. doi: 10.11648/j.ajim.20200806.16
AMA Style
Prabhash Chand Manoria, Pankaj Manoria, Rajesh Kumar Shrivastava, Sharad Kumar Parashar. Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead. Am J Intern Med. 2020;8(6):274-278. doi: 10.11648/j.ajim.20200806.16
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Download@article{10.11648/j.ajim.20200806.16,
author = {Prabhash Chand Manoria and Pankaj Manoria and Rajesh Kumar Shrivastava and Sharad Kumar Parashar},
title = {Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead},
journal = {American Journal of Internal Medicine},
volume = {8},
number = {6},
pages = {274-278},
doi = {10.11648/j.ajim.20200806.16},
url = {https://doi.org/10.11648/j.ajim.20200806.16},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20200806.16},
abstract = {Dyslipidemia is the most common modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). There is unequivocal evidence that Low Density Lipoprotein Cholesterol (LDL-C) is the main culprit. Statins, ezetimibe, bempedoic acid and Proprotein Convertase Subtilisin/ Kexin Type 9 (PCSK9) inhibitors are used to target LDL-C. Statin is always utilized as the first line therapy and they decrease LDL-C by approximately 1 mmol/l (40 mg/dL). If the LDL goals are not achieved ezetimibe is used and this decreases LDL-C by 15-20%. Bempedoic acid can also be utilized to lower LDL-C before initiating PCSK9 inhibitors but this is not available in India as yet. PCSK9 inhibitors decrease LDL-C by 1 to 1.5 mmol/l (40-60 mg/dL) on top of all lipid lowering therapy and with this very low LDL-C level targets of 150 <150 mg/dL. Inclisiran which blocks the synthesis of PCSK9 is emerging as very exciting molecule for the future. It decreases LDL-C by 50% which remains there for six months after a single injection of 300 mg.},
year = {2020}
}
TY - JOUR T1 - Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead AU - Prabhash Chand Manoria AU - Pankaj Manoria AU - Rajesh Kumar Shrivastava AU - Sharad Kumar Parashar Y1 - 2020/11/16 PY - 2020 N1 - https://doi.org/10.11648/j.ajim.20200806.16 DO - 10.11648/j.ajim.20200806.16 T2 - American Journal of Internal Medicine JF - American Journal of Internal Medicine JO - American Journal of Internal Medicine SP - 274 EP - 278 PB - Science Publishing Group SN - 2330-4324 UR - https://doi.org/10.11648/j.ajim.20200806.16 AB - Dyslipidemia is the most common modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). There is unequivocal evidence that Low Density Lipoprotein Cholesterol (LDL-C) is the main culprit. Statins, ezetimibe, bempedoic acid and Proprotein Convertase Subtilisin/ Kexin Type 9 (PCSK9) inhibitors are used to target LDL-C. Statin is always utilized as the first line therapy and they decrease LDL-C by approximately 1 mmol/l (40 mg/dL). If the LDL goals are not achieved ezetimibe is used and this decreases LDL-C by 15-20%. Bempedoic acid can also be utilized to lower LDL-C before initiating PCSK9 inhibitors but this is not available in India as yet. PCSK9 inhibitors decrease LDL-C by 1 to 1.5 mmol/l (40-60 mg/dL) on top of all lipid lowering therapy and with this very low LDL-C level targets of 150 <150 mg/dL. Inclisiran which blocks the synthesis of PCSK9 is emerging as very exciting molecule for the future. It decreases LDL-C by 50% which remains there for six months after a single injection of 300 mg. VL - 8 IS - 6 ER -
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