Physicians' Academy for Cardiovascular Education

EAS Consensus Panel Statement concludes: LDL is causal factor in ASCVD

News - Apr. 24, 2017

A new European Atherosclerosis Society (EAS) Consensus Panel Statement shows that that the total evidence from genetic studies, epidemiological studies, Mendelian randomisation studies, and randomised trials of LDL-c lowering therapies, fulfills the criteria for the causality of LDL in atherosclerotic vascular disease (ASCVD). The Consensus Panel Statement was presented today at the 85th Annual Congress of the EAS, in Prague, Czech Republic, and is published today in the European Heart Journal.

While LDL-c has long been implicated as a major modifiable CV risk factor, it has been subject of debate whether it is simply a biomarker or whether it is causal for CV disease. The EAS Consensus Statement now definitively shows that LDL causes ASCVD. By implication, therefore, targeting LDL-c sooner rather than later will have greater benefit in reducing the lifetime risk of heart attacks and strokes in high risk patients.

The statement further concludes that cumulative LDL-c burden determines the initiation and progression of ASCVD. A dose-dependent, log-linear association between absolute LDL-c and CV risk exists, which is independent of other CV risk factors and consistent across multiple lines of evidence.

The benefit from LDL-lowering therapies depends on baseline absolute CV risk, baseline LDL-c level, absolute reduction in LDL-c and duration of exposure to treatment.

Despite accumulated evidence linking LDL and ASCVD, scepticism as to whether LDL causes CVD persists. This may partly be due to selection bias, basing conclusions on individual or a small group of studies. The EAS Consensus Panel aimed to overcome this bias by considering the totality of evidence from separate meta-analyses of genetic studies and prospective epidemiological studies.

The EAS Consensus Panel Statement contains tables that indicate the potential clinical benefit derived from lowering plasma LDL-c levels. This is based on the person’s baseline CV risk, baseline LDL-c and the duration of lipid lowering therapy. These tables can aid clinicians in treatment decisions regarding LDL-c lowering therapy. Furthermore, because the effect of LDL-c on CV risk is cumulative over time, lowering LDL-c in people at high CV risk, such as those with inherited high cholesterol (FH), earlier rather than later, will undoubtedly provide greater reduction in their lifetime risk of an event.

Source: press release EAS April 24 2017


Show references

Find the EAS Consensus Panel online at Eur Heart J