Lipid management in ACS: Should we go lower faster?

Atherosclerosis
Baris Gencer, François Mach

Abstract

Low-density lipoprotein-cholesterol (LDL-C) is a well-accepted causal risk factor for athero-thrombotic cardiovascular disease, as demonstrated in large epidemiological studies, including Mendelian randomization data. Several randomized controlled trials and meta-analyzes have shown that lipid lowering therapies, such as statins and more recently the non-statin agents ezetimibe and Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) monoclonal antibodies (mAb), reduce cardiovascular events across a broad range of baseline LDL-C levels. Over time, the recommended target for LDL-C has become more stringent, moving from 2.6 mmol/l to 1.8 mmol/l in very high-risk patients. It is currently recommended to start high intensity statin treatment immediately after acute coronary syndromes (ACS) to maximally and rapidly reduce LDL-C. The novel treatment options enable the achievement of very low LDL-C levels below 1 mmol/l, with no reported safety issues, in particular with regard to neurocognitive events. However, current evidence supports the use of PCSK9 mAb treatment in ACS patients only after an initial 2-3 month run-up treatment adaptation period with maximally tolerated statin. The use of PCSK9 mAb immediately in the acute phase ...Continue Reading

Citations

Jan 22, 2019·Therapeutic Apheresis and Dialysis : Official Peer-reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy·Volker Jj SchettlerClaas-Lennart Neumann
May 12, 2019·British Journal of Clinical Pharmacology·Giuseppe LippiGianfranco Cervellin
Oct 3, 2020·Antioxidants·Melanie ZieglerKarlheinz Peter
May 1, 2021·Journal of Clinical Medicine·Gabriella IannuzzoFrancesco Giallauria
Jun 3, 2021·International Journal of Molecular Sciences·Cristina BaraleIsabella Russo

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