PCSK9: Outcomes and trials in clinical perspective PCSK9 inhibitors should be mainly considered for the highest risk categories on maximally tolerated statin plus ezetimibe. Prof. Kees Hovingh discusses how to identify these high risk patients.

The working group on atherosclerosis and vascular biology of the European Society of Cardiology published a position paper, which provides consensus statements on how to identify anti-inflammatory effects of lipid-lowering therapy.

A retrospective review showed that children with FH and family history of early-onset ASCVD were more likely to have Lp(a) ≥50 mg/dL, compared with children with FH and family history of late-onset ASCVD.

PCSK9: Outcomes and trials in clinical perspective There is still a high (residual) risk for future events in many high risk ASCVD patients, despite maximally tolerated statin therapy. Prof. Jukema discusses the use of PCSK9 inhibitors in these high risk patients and the recommendations from international guidelines.

This is a summary of the presentation by prof. Stephan Jacob, in which he talked about the management of diabetes, focusing on the shift from glucose to CV risk management in patients with diabetes.

Currently only small numbers of ASCVD patients achieve target LDL-c levels due to certain issues surrounding lipid lowering therapy. Prof. John Kastelein discusses the role of PCSK9 inhibition and future perspectives on lipid lowering.

A post-hoc analysis showed reduced LDL-c levels and improved lipid profiles up to 180 days with one or two doses of inclisiran on top of standard care in the presence and absence of diabetes, compared to placebo.

PCSK9: Outcomes and trials in clinical perspective Prof. Steg summarizes the main results from recent clinical trials with PCSK9 inhibitors and presents some additional analyses in subgroups.

A Mendelian randomization study combined with metabolic biomarker analysis shows that CETP is an important causal determinant of HDL and VLDL concentration and composition.

AHA 2018 Lp(a) is a highly prevalent risk factor, with to date no therapy to lower its levels. A phase 2b study now shows that an antisense oligonucleotide potently lowers production of Lp(a), to optimal levels.

AHA 2018 Post-hoc analyses of the ODYSSEY OUTCOMES trial showed reduced all-cause mortality with alirocumab vs statins in patients with ACS, especially in those with LDL-c of ≥100 mg/dL at baseline.

AHA 2018 In Japanese patients aged ≥75 years with elevated LDL-c levels, ezetimibe results in prevention of atherosclerotic CV events, as shown in the EWTOPIA75 randomized trial.