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From the Editors

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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Paediatric FH: what do we still need to know?

Paediatric FH: what do we still need to know?

FH is a common inherited hyperlipidaemia, characterized by elevated cholesterol levels from birth which, if untreated, lead to accelerated atherosclerosis and premature coronary artery disease in adulthood. Clearly, there is an urgent need to identify these individuals in childhood so as to instigate treatment as…

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Looking back at 2017 and forward to 2018

Looking back at 2017 and forward to 2018

PCSK9 Forum Editor Professor Anthony Wierzbicki (St Thomas’ Hospital, London UK) discusses the key trials in cardiovascular disease prevention in 2017 and what 2018 offers.

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Evolocumab in lower extremity peripheral artery disease

Evolocumab in lower extremity peripheral artery disease

Lower extremity peripheral artery disease (LEPAD) is associated with an elevated risk of atherosclerotic cardiovascular disease (ASCVD) and mortality1. Classically, risk factors for LEPAD are heavy smoking, diabetes and older age, although dyslipidaemia also predisposes to LEPAD, as shown by a recent study2. Furthermore, Pereira…

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Depression, Cardiovascular Disease and Adherence

Depression, Cardiovascular Disease and Adherence

David Hare & Samia R Toukhsati, University of Melbourne, Australia This editorial discusses the interrelationship between cardiovascular disease and depression and poses the question: Is depression a key modulator of patient adherence and clinical outcome? “Depression” can refer to anything from feeling transiently unhappy through…

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PlayESC/EAS Task Force issues updated clinical guidance for PCSK9 inhibitors

ESC/EAS Task Force issues updated clinical guidance for PCSK9 inhibitors

This Task Force from the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) has considered new evidence from cardiovascular outcomes studies with evolocumab (FOURIER) and bococizumab (now terminated), new analyses and genetic studies.t Taking account of the cost of these agents, the Task…

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REVEAL Study. Should we welcome a new lipid lowering drug family?

REVEAL Study. Should we welcome a new lipid lowering drug family?

The significant and positive results obtained by REVEAL (Randomized EValuation of the Effects of Anacetrapib Through Lipid-modification study) (1) are good news. These data show that we have a new lipid modifying drug, that by significantly reducing atherogenic non-high-density lipoprotein (HDL) cholesterol, decreases major cardiovascular…

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PlayWill CANTOS and REVEAL change how we view the clinical use of PCSK9 inhibitors?

Will CANTOS and REVEAL change how we view the clinical use of PCSK9 inhibitors?

Prof Anthony Wierzbicki, New Associate Editor of PCSK9 Forum discusses Atherosclerosis has long been recognised as a chronic inflammatory disease, where low-density lipoproteins (LDL) interact with both innate and adaptive immunity mechanisms. However, while inflammatory infiltration by circulating white blood cells is an important part…

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NLA 2017 recommendations: Who should benefit from PCSK9 inhibition?

NLA 2017 recommendations: Who should benefit from PCSK9 inhibition?

Dr Peter Lansberg, PCSK9 Forum News Editor discusses these latest recommendations from the US National Lipid Association. The National Lipid Association has recently published updated guidance for the use of PCSK9 inhibitors (1). This statement has courted controversy with recommendations for using these efficacious agents…

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PlayImplications of very low LDL cholesterol levels

Implications of very low LDL cholesterol levels

One of the key concerns of clinicians in the aftermath of FOURIER is the safety of very low LDL cholesterol levels. This is underlined by the fact that 42% of patients on evolocumab in FOURIER attained LDL cholesterol levels ≤25 mg/dl (0.65 mmol/L).(1) As previously…

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PlayFOURIER in the Hot Seat: What are the Implications for practice and access?

FOURIER in the Hot Seat: What are the Implications for practice and access?

FOURIER was a landmark trial for PCSK9 inhibition, showing significant reduction in cardiovascular events with evolocumab in very high risk patients on maximally tolerated lipid lowering therapy. The results from FOURIER, together with those from SPIRE-2 in patients at higher baseline LDL cholesterol levels, clearly…

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PlayCountdown to FOURIER: What are the implications for patients?

Countdown to FOURIER: What are the implications for patients?

Countdown to FOURIER: What are the implications for patients? PCSK9 Forum Editor Professor Anthony Wierzbicki gives his view.

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Countdown to FOURIER: Are very low levels of LDL cholesterol safe?

Countdown to FOURIER: Are very low levels of LDL cholesterol safe?

A view from PCSK9 Forum Editor Dr Peter Lansberg (Academic Medical Center, Amsterdam, the Netherlands) Comment relates to: Giugliano RP, Wiviott SD, Blazing MA et al. Long-term Safety and Efficacy of Achieving Very Low Levels of Low-Density Lipoprotein Cholesterol A Prespecified Analysis of the IMPROVE-IT…

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