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From the Editors

LDL cholesterol targets in stroke patients: where to?

LDL cholesterol targets in stroke patients: where to?

Professor Pierre Amarenco, Bichat Hospital, University of Paris, France, makes the case for reconsideration of LDL cholesterol targets to prevent stroke, based on evidence from recent trials.  Stroke is a major contributor to the global cardiovascular disease burden (1). Major modifiable risk factors including elevated…

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PCSK9 inhibition, low LDL cholesterol and lack of cognitive impairment: QED?

PCSK9 inhibition, low LDL cholesterol and lack of cognitive impairment: QED?

Prof Derick Raal, University of the Witwatersrand, Johannesburg, South Africa, discusses the latest data from FOURIER regarding cognitive safety. What is the take home message for clinicians? Clinicians have long been concerned about ‘going too low’ when prescribing lipid-lowering therapy. A key issue is whether…

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PCSK9 inhibition: impact on stroke

PCSK9 inhibition: impact on stroke

Prof Raul Santos, from the Heart Institute (InCor) University of Sao Paulo Medical School Hospital and the Hospital Israelita Albert Einstein, São Paulo, Brazil discusses the latest findings from FOURIER. Stroke brings a high burden of individual and family suffering, in addition to elevated health…

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Monogenic versus polygenic familial hypercholesterolaemia: how does cardiovascular risk compare?

Monogenic versus polygenic familial hypercholesterolaemia: how does cardiovascular risk compare?

Professor Derick Raal, University of the Witwatersrand, Johannesburg, South Africa Familial hypercholesterolaemia (FH, inherited high cholesterol) is one of the most common inherited disorders, affecting approximately one in every 250 people or over 30 million people worldwide.  FH is usually caused by pathogenic variants in…

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Managing homozygous FH: what can we learn from TAUSSIG?

Managing homozygous FH: what can we learn from TAUSSIG?

Professor Eric Bruckert (Hôpital Pitié Salpêtrière, Paris, France) gives his perspective on the take home messages from TAUSSIG.  Patients with homozygous familial hypercholesterolaemia (FH) are extremely difficult to manage. High LDL cholesterol levels associated with this disorder put patients at very high risk of premature…

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Are we doing any better with familial hypercholesterolaemia care?

Are we doing any better with familial hypercholesterolaemia care?

Professor Eric Bruckert, Pitié-Salpêtrière Hospital, Paris, France In the last 5 years, there has been a drive to improve the care of familial hypercholesterolaemia (FH), one of the most common inherited disorders, affecting as many as 1 in 200-250 individuals worldwide.1,2 This follows on from…

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Targeting PCSK9 inhibitors to the right patient

Targeting PCSK9 inhibitors to the right patient

Professor Stephen J Nicholls MBBS PhD, Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia  The clinical development of pharmacological inhibitors of proprotein convertase subtilisin kexin type 9 (PCSK9) has received considerable attention by virtue of the expectation that these treatments would have the potential to…

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LDL cholesterol goals in patients with diabetes – How low?

LDL cholesterol goals in patients with diabetes – How low?

Professor Derick Raal, University of the Witwatersrand, Johannesburg, South Africa. Patients with diabetes and a history of acute coronary syndrome (ACS) are at enhanced risk of recurrent events and death compared with those without diabetes.1 Does this mean that treatment with a PCSK9 inhibitor will…

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Surfing the PCSK9 wave of discovery

Surfing the PCSK9 wave of discovery

Prof Derick Raal (University of Witwatersrand, Johannesburg, South Africa) gives his perspective on the newest ‘PCSK9 kids on the block’ amidst the wave of PCSK9 discovery. In 2012, there was the first clinical evidence of dramatic reductions in LDL cholesterol by inhibiting PCSK9 with monoclonal…

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Did someone say “Beyond LDL-cholesterol”?

Did someone say “Beyond LDL-cholesterol”?

PCSK9 Forum Editor Professor John Chapman (Pitié-Salpétrière University Hospital, and Sorbonne University, Paris, France) discusses how ‘OMICS’ technologies could provide a precision medicine approach to managing non-LDL lipids. As a causal factor in atherosclerotic cardiovascular disease (ASCVD), measurement of LDL cholesterol has facilitated enormous progress…

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Coronary artery calcium in familial hypercholesterolaemia

Coronary artery calcium in familial hypercholesterolaemia

Coronary artery calcium (CAC) score may have a role in stratifying short-term risk in patients with familial hypercholesterolaemia (FH, inherited high cholesterol), according to a new study. The authors suggest that this noninvasive approach may have value in targeting treatment with a PCSK9 inhibitor to…

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Stratifying risk in familial hypercholesterolaemia: does coronary artery calcium have a role?

Stratifying risk in familial hypercholesterolaemia: does coronary artery calcium have a role?

PCSK9 Forum Editors Professor Gerald Watts (University of Western Australia, Perth, Australia) and Professor Derick Raal (University of the Witwatersrand, Johannesburg, South Africa) give their view. As a result of life-long exposure to high LDL cholesterol levels, individuals with familial hypercholesterolaemia (FH, inherited high cholesterol)…

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New US Cholesterol Guidelines: The good, the bad and the ugly

New US Cholesterol Guidelines: The good, the bad and the ugly

PCSK9 Forum Editor Professor Henry Ginsberg, Columbia University, New York, USA. The new guidelines might be viewed as a remake of the great spaghetti western called “The Good, the Bad, and the Ugly.” The Good includes recommendations for personalized discussions with patients that address short-…

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A new genetic mechanism for familial hypercholesterolaemia:  PCSK9 whole gene duplication

A new genetic mechanism for familial hypercholesterolaemia: PCSK9 whole gene duplication

Prof Robert A. Hegele, Robarts Research Institute, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada Familial hypercholesterolemia (FH, inherited high cholesterol) patients continue to teach us new things about lipid metabolism.  A case in point is our recent report of two Canadian…

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Is LDL-apheresis still needed in the PCSK9 era?

Is LDL-apheresis still needed in the PCSK9 era?

Dr Peter Lansberg, University Medical Center Groningen, The Netherlands  With the successful introduction of PCSK9 monoclonal antibodies, patients are now able to dramatically reduce severely elevated LDL-cholesterol levels by up to 80-90%, when combined with statins and ezetimibe [1]. The recently published TAUSSIG study showed…

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The lipoprotein(a) – LDL cholesterol conundrum

The lipoprotein(a) – LDL cholesterol conundrum

Prof Derick Raal, University of the Witwatersrand, Johannesburg, South Africa The last decade has seen a resurgence of interest in lipoprotein(a) [Lp(a)], the mysterious brother of LDL (low-density lipoprotein). Indeed, there is now established evidence that Lp(a) is an independent risk factor for cardiovascular disease…

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Lipoprotein(a) – does it matter when LDL cholesterol is low?

Lipoprotein(a) – does it matter when LDL cholesterol is low?

Lipoprotein(a) is now recognised as an independent risk factor for cardiovascular disease. But is it also relevant to consider lipoprotein(a) when LDL cholesterol is low? Prof. Anthony S Wierzbicki, Guy’s and St Thomas’ Hospitals, London, UK discusses the evidence. Lipoprotein(a) [Lp(a)] is a well-characterised biomarker…

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PCSK9 Monoclonal Antibody Therapy in Patients with Diabetes: Where We Are and Future Needs

PCSK9 Monoclonal Antibody Therapy in Patients with Diabetes: Where We Are and Future Needs

Patients with type 2 diabetes are at increased risk of cardiovascular disease events, especially if pre-existing atherosclerotic cardiovascular disease (ASCVD) is present. Indeed, recent guidelines from the American Association of Clinical Endocrinologists (AACE) have classified these patients as being at “extreme risk” and thus requiring…

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PSCK9 inhibitor therapy- after the clinical trials, what can we learn to improve practice?

PSCK9 inhibitor therapy- after the clinical trials, what can we learn to improve practice?

The major cardiovascular disease (CVD) outcomes trials with the antibody-based inhibitors of proprotein convertase subtilisin kexin type 9 (PCSK9) have now been completed. Both ODYSSEY Outcomes with alirocumab in patients with acute coronary syndromes (ACS) and FOURIER with evolocumab in patients with stable CVD, were…

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New Approaches to PCSK9 inhibition

New Approaches to PCSK9 inhibition

Prof Derick Raal (University of Witwatersrand, Johannesburg, South Africa) discusses what’s in the pipeline for PCSK9 inhibition beyond the monoclonal antibodies. PCSK9 monoclonal antibodies Modulation of PCSK9 can result in much greater lowering of LDL-cholesterol than that achieved with statin therapy or statin therapy in…

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