In a subanalysis of the FOURIER trial, treatment with evolocumab in patients with higher baseline Lp(a) resulted in non-significant greater percent reduction and greater absolute reduction of coronary events, compared to those with low baseline Lp(a).

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.

In the ANITSCHKOW study, 16 weeks of treatment with evolocumab in patients with elevated Lp(a) levels, did not significantly alter arterial wall inflammation, despite lowering Lp(a) by 14%.

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.

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.

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.

PCSK9: Outcomes and trials in clinical perspective Prof. Chapman explains the biology of PCSK9, its role in the regulation of LDL-R expression and the impact of a therapeutic approach with PCSK9 inhibitors.

AHA 2018 In the ANITSCHKOW study, patients with very high Lp(a) were treated with evolocumab 420 mg once monthly. The 14% lowering in Lp(a) was not sufficient to eliminate the inflammatory stimulans induced by Lp(a).

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 Neil Stone served as vice-president of the new cholesterol guideline. He sums up the main new recommendations based on the latest evidence of recent lipid outcome trials.