Physicians' Academy for Cardiovascular Education

Key messages on LDL-c and CV risk

Apr. 11, 2019

The following key messages have been formulated based on an expert meeting (held December 14, 2018) among European cardiologists and internists, around the topic of ‘LDL-c and PCSK9 inhibition in high CV risk patients. Balancing science, guidelines and daily cardiology practice’.

Click on the statements to read brief explanations of what the statements are based on, including references.

LDL biology/atherogenesis

Therapeutic considerations

Concept changes in lipid-lowering therapy to lower CV risk

Based on the key messages listed above, the following principles can be formulated that should form the basis of lipid-lowering therapy to lower CV risk.

1. Use combination therapy

2. Start early

3. Treat more aggressively

Emerging concept of multifactorial CV risk management

In addition to lipid-lowering, a broader concept of CV risk management in coronary disease is emerging, which should include:

1. Lipoprotein-modifying therapy: lower LDL-c earlier and more aggressively (and TRLP and Lp(a)).

2. Blood pressure-lowering therapy: target SBP 120-130 mmHg (note U-curve).

3. Antidiabetic therapy: lower CV risk (CAD and/or risk of HF events) with SGLT2i and/or GLP-1ra

4. Antithrombotic therapy: prolonged DAPT? Low-dose anticoagulation?

5. Anti-inflammatory therapy: target IL-1β

6. Future: target microbiome …?

Better algorithms on which patient to treat when with what, and better risk estimation are needed. Moreover, there is a need for better risk prediction of adverse events. 

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