The next chapter of prevention: from LDL-cholesterol to lipoprotein(a) and triglycerides

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Cómo se estudió

Diseño

Ensayo controlado aleatorizado (clasificado por nuestro filtro de IA)

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Personas

Resultado principal

Eventos clínicos como enfermedad o muerte

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Financiación

Financiación no declarada

Publicación

Publicado

2020-06-21 · Eur Heart J · vol. 41 · número 24 · págs. 2227–2230

Editorial

Oxford University Press

Citado

4 citas · más que el 67% de estudios similares · 0.6× el promedio de su campo

Referencias

29 trabajos

Acceso

De pago

Áreas de investigación

Lipoproteins and Cardiovascular Health · Diabetes, Cardiovascular Risks, and Lipoproteins · Lipid metabolism and disorders

Palabras clave

lipoprotein(a), triglycerides, atherosclerotic cardiovascular disease, LDL cholesterol, PCSK9 inhibitors, alirocumab, acute coronary syndrome, elderly patients, statins, lipid-lowering therapy, cardiovascular disease prevention, major adverse cardiovascular events, all-cause mortality, number needed to treat, hypertriglyceridemia, dyslipidemia, cardiovascular risk stratification

MeSH

humans, cholesterol, triglycerides, lipoprotein(a), cholesterol, ldl, cholesterol, hdl

1 autor

• Thomas Felix Lüscher🇨🇭🇬🇧 · autor de correspondenciaUniversity of Zurich; Royal Brompton & Harefield NHS Foundation Trust; Harefield Hospital; Royal Brompton Hospital; Zurich Heart House; Imperial College London

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For the podcast associated with this article, please visit https://academic.oup.com/eurheartj/pages/Podcasts. Lipids are known to be major drivers of atherosclerotic cardiovascular disease (ASCVD1,2). Statins and inhibitors of intestinal cholesterol uptake are the mainstay of cardiovascular prevention and have markedly improved outcomes of patients with ASCVD.3 With proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors can be lowered further to extremely low values and outcomes further improved.4 While lipid lowering is well accepted in most patients, the elderly with ASCVD are commonly undertreated. Indeed, age has been an issue, and many physicians are still reluctant to consider statins in the elderly, although stopping statins markedly increases events in this age group.5 In the FAST TRACK ‘Effect of alirocumab on cardiovascular outcomes after acute coronary syndromes according to age: an ODYSSEY OUTCOMES trial analysis’ Peter Sinnaeve from the University Hospital Gasthuisberg in Leuven, Belgium and colleagues address this issue for PCSK9 inhibitors.6 This pre-specified analysis from ODYSSEY OUTCOMES compared the effect of alirocumab vs. placebo in 18 924 patients with recent acute coronary syndrome (ACS) according to age. Relative risk reductions were consistent for patients ≥65 vs. <65 years for major cardiovascular events (MACE), with hazard ratios of 0.78 and 0.89, respectively and for all-cause death with 0.77 vs. 0.94, respectively. For MACE when dichotomizing at age 75, hazard ratios were 0.85 (95% confidence interval 0.64–1.13) in those aged ≥75 and 0.85 (95% confidence interval 0.78–0.93) below this age. When considering age as a continuous variable, advancing age increased MACE, as well as the absolute reduction in MACE with alirocumab, with numbers needed to treat at 3 years of 43 at age 45, 26 at age 75, and 12 at age 85 years. Although adverse events were more frequent in older patients, there were no differences between alirocumab and placebo. Thus, in patients with recent ACS, alirocumab improves outcomes irrespective of age. Whether LDL-cholesterol (LDL-C) lowering is an important preventive intervention for older patients after ACS is further discussed in a thought-provoking Editorial by Erik Stroes from the Amsterdam University Medical Center in Amsterdam, the Netherlands.7

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