Evolving Management of Low-Density Lipoprotein Cholesterol: A Personalized Approach to Preventing Atherosclerotic Cardiovascular Disease Across the Risk Continuum

被引:13
作者
Wilkinson, Michael J. [1 ,5 ]
Lepor, Norman E. [2 ,3 ]
Michos, Erin D. [4 ]
机构
[1] Univ Calif San Diego, Dept Med, Div Cardiovasc Med, San Diego, CA USA
[2] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA USA
[3] Cedars Sinai Med Ctr, Los Angeles, CA USA
[4] Johns Hopkins Univ, Sch Med, Div Cardiol, Baltimore, MD USA
[5] Univ Calif San Diego, Cardiovasc Inst, Div Cardiovasc Med, Dept Med, 9434 Med Ctr Dr 7214, La Jolla, CA 92037 USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2023年 / 12卷 / 11期
关键词
atherosclerosis; atherosclerotic cardiovascular disease; lipids; low-density lipoprotein cholesterol; prevention; CORONARY-HEART-DISEASE; INTENSITY STATIN THERAPY; VERY-LOW LEVELS; BEMPEDOIC ACID; LDL-CHOLESTEROL; FAMILIAL HYPERCHOLESTEROLEMIA; ARTERY CALCIUM; EFFICACY; SAFETY; INCLISIRAN;
D O I
10.1161/JAHA.122.028892
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Management of elevated low-density lipoprotein cholesterol (LDL-C) is central to preventing atherosclerotic cardiovascular disease (ASCVD) and key to reducing the risk of ASCVD events. Current guidelines on the management of blood cholesterol recommend statins as first-line therapy for LDL-C reduction according to an individual's ASCVD risk and baseline LDL-C levels. The addition of nonstatin lipid-lowering therapy to statins to achieve intensive LDL-C lowering is recommended for patients at very high risk of ASCVD events, including patients with familial hypercholesterolemia who have not achieved adequate LDL-C lowering with statins alone. Despite guideline recommendations and clinical trial evidence to support the use of lipid-lowering therapies for ASCVD risk reduction, most patients at high or very high risk do not meet LDL-C thresholds. This review explores the challenges associated with LDL-C lowering in contemporary clinical practice and proposes a framework for rethinking the binary definition of ASCVD, shifting from "primary" versus "secondary" prevention to a "continuum of risk." The approach considers the role of plaque burden and progression in subclinical disease and emphasizes the importance of early risk assessment and treatment for preventing first cardiovascular events. Patients at high risk of ASCVD events who require significant LDL-C lowering should be considered for combination therapies comprising statin and nonstatin agents. Practical guidance for the pharmacological management of elevated LDL-C, both now and in the future, is provided.
引用
收藏
页数:22
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共 149 条
[91]   Systematic Lab Knowledge Integration for Management of Lipid Excess in High-Risk Patients: Rationale and Design of the SKIM LEAN Project [J].
Pavanello, Chiara ;
Parolini, Marina ;
Alberti, Antonia ;
Carenini, Michele ;
Maino, Paolo ;
Mombelli, Giuliana ;
Pazzucconi, Franco ;
Origgi, Gianni ;
Orsi, Federica ;
Trivella, Maria Giovanna ;
Calabresi, Laura ;
De Maria, Renata .
FRONTIERS IN BIG DATA, 2018, 1
[92]   Ezetimibe therapy: mechanism of action and clinical update [J].
Phan, Binh An P. ;
Dayspring, Thomas D. ;
Toth, Peter P. .
VASCULAR HEALTH AND RISK MANAGEMENT, 2012, 8 :415-427
[93]  
PRALUENT®, 2017, PRESCRIBING INFORM
[94]   Evinacumab for Homozygous Familial Hypercholesterolemia [J].
Raal, Frederick J. ;
Rosenson, Robert S. ;
Reeskamp, Laurens F. ;
Hovingh, G. Kees ;
Kastelein, John J. P. ;
Rubba, Paolo ;
Ali, Shazia ;
Banerjee, Poulabi ;
Chan, Kuo-Chen ;
Gipe, Daniel A. ;
Khilla, Nagwa ;
Pordy, Robert ;
Weinreich, David M. ;
Yancopoulos, George D. ;
Zhang, Yi ;
Gaudet, Daniel .
NEW ENGLAND JOURNAL OF MEDICINE, 2020, 383 (08) :711-720
[95]   Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia [J].
Raal, Frederick J. ;
Kallend, David ;
Ray, Kausik K. ;
Turner, Traci ;
Koenig, Wolfgang ;
Wright, R. Scott ;
Wijngaard, Peter L. J. ;
Curcio, Danielle ;
Jaros, Mark J. ;
Leiter, Lawrence A. ;
Kastelein, John J. P. .
NEW ENGLAND JOURNAL OF MEDICINE, 2020, 382 (16) :1520-1530
[96]   Effect of Alirocumab Added to High-Intensity Statin Therapy on Coronary Atherosclerosis in Patients With Acute Myocardial Infarction The PACMAN-AMI Randomized Clinical Trial [J].
Raber, Lorenz ;
Ueki, Yasushi ;
Otsuka, Tatsuhiko ;
Losdat, Sylvain ;
Haner, Jonas D. ;
Lonborg, Jacob ;
Fahrni, Gregor ;
Iglesias, Juan F. ;
van Geuns, Robert-Jan ;
Ondracek, Anna S. ;
Radu Juul Jensen, Maria D. ;
Zanchin, Christian ;
Stortecky, Stefan ;
Spirk, David ;
Siontis, George C. M. ;
Saleh, Lanja ;
Matter, Christian M. ;
Daemen, Joost ;
Mach, Francois ;
Heg, Dik ;
Windecker, Stephan ;
Engstrom, Thomas ;
Lang, Irene M. ;
Koskinas, Konstantinos C. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2022, 327 (18) :1771-1781
[97]   Changes in Coronary Plaque Composition in Patients With Acute Myocardial Infarction Treated With High-Intensity Statin Therapy (IBIS-4) A Serial Optical Coherence Tomography Study [J].
Raeber, Lorenz ;
Koskinas, Konstantinos C. ;
Yamaji, Kyohei ;
Taniwaki, Masanori ;
Roffi, Marco ;
Holmvang, Lene ;
Garcia, Hector M. Garcia ;
Zanchin, Thomas ;
Maldonado, Rafaela ;
Moschovitis, Aris ;
Pedrazzini, Giovanni ;
Zaugg, Serge ;
Dijkstra, Jouke ;
Matter, Christian M. ;
Serruys, Patrick W. ;
Luescher, Thomas F. ;
Kelbaek, Henning ;
Karagiannis, Alexios ;
Radu, Maria D. ;
Windecker, Stephan .
JACC-CARDIOVASCULAR IMAGING, 2019, 12 (08) :1518-1528
[98]  
Ray KK, 2021, EUR HEART J, V42, P2580
[99]   EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study [J].
Ray, Kausik K. ;
Molemans, Bart ;
Schoonen, W. Marieke ;
Giovas, Periklis ;
Bray, Sarah ;
Kiru, Gaia ;
Murphy, Jennifer ;
Banach, Maciej ;
De Servi, Stefano ;
Gaita, Dan ;
Gouni-Berthold, Ioanna ;
Hovingh, G. Kees ;
Jozwiak, Jacek J. ;
Jukema, J. Wouter ;
Kiss, Robert Gabor ;
Kownator, Serge ;
Iversen, Helle K. ;
Maher, Vincent ;
Masana, Luis ;
Parkhomenko, Alexander ;
Peeters, Andre ;
Clifford, Piers ;
Raslova, Katarina ;
Siostrzonek, Peter ;
Romeo, Stefano ;
Tousoulis, Dimitrios ;
Vlachopoulos, Charalambos ;
Vrablik, Michal ;
Catapano, Alberico L. ;
Poulter, Neil R. .
EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, 2021, 28 (11) :1279-1289
[100]   Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol [J].
Ray, Kausik K. ;
Wright, R. Scott ;
Kallend, David ;
Koenig, Wolfgang ;
Leiter, Lawrence A. ;
Raal, Frederick J. ;
Bisch, Jenna A. ;
Richardson, Tara ;
Jaros, Mark ;
Wijngaard, Peter L. J. ;
Kastelein, John J. P. .
NEW ENGLAND JOURNAL OF MEDICINE, 2020, 382 (16) :1507-1519