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Early discontinuation of PCSK9 inhibitors problematic in practice

Early discontinuation of PCSK9 inhibitors problematic in practice

Over one-quarter of patients prescribed a PCSK9 inhibitor stop treatment within 6 months, according to this analysis of real-world practice. Landmark clinical trials – FOURIER with evolocumab and ODYSSEY OUTCOMES with alirocumab – have confirmed the benefit of PCSK9 inhibition, against a background of statin…

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Higher PCSK9 levels in patients with peripheral artery disease

Higher PCSK9 levels in patients with peripheral artery disease

Results from the CAVASIC study indicate that higher PCSK9 levels associate with peripheral artery disease (PAD), independent of other lipid variables or cardiovascular risk factors. The CAVASIC (CArdioVAScular disease in patients with Intermittent Claudication) Study was initiated in Austria in 2002 to identify cardiovascular risk…

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New Cochrane analysis reaffirms role for PCSK9 inhibitors

New Cochrane analysis reaffirms role for PCSK9 inhibitors

A new analysis including data on more than 60,000 patients reaffirms guideline recommendations for the use of PCSK9 monoclonal antibody therapy in high and very high-risk patients needing additional LDL cholesterol reduction to attain goals. This latest Cochrane analysis addressed a key question: What is…

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New guidance for familial hypercholesterolaemia care in Australia

New guidance for familial hypercholesterolaemia care in Australia

The FH Australasia Network Consensus Working Group has published new evidence-informed guidance to improve the care of familial hypercholesterolaemia (FH, inherited high cholesterol) in the Australasia region. Driving this update to the 2011 guidance is the tsunami of publications about FH (1), as well as…

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News from South Africa: The Wits FIND-FH Program

News from South Africa: The Wits FIND-FH Program

This report discusses this phenotypic cascade screening program, much needed in South Africa. Familial hypercholesterolaemia (FH, inherited high cholesterol) is one of the commonest inherited diseases in the world, affecting about one in 250 to 300 of White populations (1). However, some countries such as…

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Two Lancet studies make the case for treating high LDL cholesterol in the ‘healthy’ elderly

Two Lancet studies make the case for treating high LDL cholesterol in the ‘healthy’ elderly

In the primary prevention setting, individuals aged 75 years or older with elevated LDL cholesterol are at higher absolute cardiovascular risk than those who are younger. These people would gain from lipid lowering treatment, which is as efficacious as in younger age groups. These are…

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News from ODYSSEY OUTCOMES: Lipoprotein(a) lowering is an independent contributor to total cardiovascular event reduction with alirocumab

News from ODYSSEY OUTCOMES: Lipoprotein(a) lowering is an independent contributor to total cardiovascular event reduction with alirocumab

Lipoprotein(a) lowering contributed to total cardiovascular event reduction in acute coronary syndrome (ACS) patients independent of the effects of alirocumab on LDL cholesterol, according to this analysis of ODYSSEY OUTCOMES. The ODYSSEY OUTCOMES trial previously reported that lowering lipoprotein(a) [Lp(a)] with alirocumab reduced the risk…

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LDL lipidomics: are bioactive lipids biomarkers for cardiometabolic risk?

LDL lipidomics: are bioactive lipids biomarkers for cardiometabolic risk?

This report addressed two key questions. Can the bioactive lipid cargo differentiate LDL subclasses, and thus potential atherogenicity?  And if so, what is the effect of statin therapy? The human plasma lipidome is composed of many molecular lipid species, showing diverse physicochemical and biological properties….

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Evolocumab with statin/ezetimibe combination may be cost-effective in MI patients: Swedish analysis

Evolocumab with statin/ezetimibe combination may be cost-effective in MI patients: Swedish analysis

An analysis from the Swedish perspective concludes that treatment with the PCSK9 inhibitor evolocumab on top of statin and ezetimibe may be cost-effective in MI patients. While the PCSK9 inhibitors are undoubtedly highly efficacious in lowering LDL cholesterol and reduce cardiovascular events in high and…

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PCSK9 inhibition improves coronary endothelial function in people living with HIV

PCSK9 inhibition improves coronary endothelial function in people living with HIV

People living with human immunodeficiency virus (HIV) infection are at increased risk of atherosclerotic cardiovascular disease (ASCVD) compared with those without this infection despite more extensive use of antiretroviral therapy and increased use of statin therapy (1). This increased risk relates to the presence of…

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Eligibility for PCSK9 inhibitors: Europe versus the US guidelines

Eligibility for PCSK9 inhibitors: Europe versus the US guidelines

According to this report, about half of all patients hospitalised for an acute coronary syndrome (ACS) would be eligible for treatment with a PCSK9 inhibitor, based on the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines. This contrasts with about one in…

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FOURIER: Benefit from evolocumab in different MI subtypes

FOURIER: Benefit from evolocumab in different MI subtypes

A new analysis from the FOURIER study suggests that lowering LDL cholesterol with evolocumab led to benefit across various myocardial infarction (MI) subtypes linked to plaque rupture. The Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) study previously demonstrated significant…

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Circulating PCSK9 critical for regulating postprandial lipaemia

Circulating PCSK9 critical for regulating postprandial lipaemia

Data from an experimental model provide support for clinically relevant effects of PCSK9 inhibitors in reducing postprandial lipaemia, especially in patients with type 2 diabetes mellitus. Elevated postprandial lipaemia is an independent risk factor for atherosclerotic cardiovascular disease (1). In previous studies using a mouse…

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More from The Treat Stroke to Target (TST) trial: greater regression of atherosclerosis at lower LDL-C

More from The Treat Stroke to Target (TST) trial: greater regression of atherosclerosis at lower LDL-C

Attaining lower LDL cholesterol levels in patients with ischaemic stroke of atherosclerotic origin led to greater regression of carotid atherosclerosis compared with those at higher LDL cholesterol levels. The results lend further support for lower LDL cholesterol levels in stroke patients. With uncertainty around specific…

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Evolocumab versus ezetimibe: Further data to guide clinical decision making

Evolocumab versus ezetimibe: Further data to guide clinical decision making

Evolocumab outperformed ezetimibe in terms of efficacy and achievement of lipid goals, according to this latest pooled analysis of Phase 3 studies in the PROFICIO development program for evolocumab. High-intensity statin treatment is the cornerstone of lipid lowering therapy for patients at high- and very…

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ORION-2 with inclisiran in homozygous familial hypercholesterolaemia

ORION-2 with inclisiran in homozygous familial hypercholesterolaemia

First reported at the 87th European Atherosclerosis Society Congress in Maastricht, The Netherlands, the ORION-2 study has now been published. ORION-2 was an open-label, proof-of-concept study that investigated inclisiran, an siRNA therapeutic targeting PCSK9, in four patients with a clinical or genetic diagnosis of homozygous…

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Pooled analyses confirm benefit of PCSK9 inhibitors on secondary lipid targets

Pooled analyses confirm benefit of PCSK9 inhibitors on secondary lipid targets

Guidelines for managing dyslipidemia have emphasized the use of non-high-density lipoprotein (HDL) cholesterol, apolipoprotein (Apo)B and lipoprotein(a) for risk stratification (1,2). Two new pooled analyses provide information about the effects of evolocumab and alirocumab on these secondary targets. While LDL cholesterol is the primary lipid…

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ODYSSEY OUTCOMES economics study reinforces highest risk-highest benefit premise

ODYSSEY OUTCOMES economics study reinforces highest risk-highest benefit premise

Alirocumab treatment in the acute coronary syndrome (ACS) setting was best-value in statin-treated patients with persistently elevated LDL cholesterol levels (≥100 mg/dL or 2.6 mmol/L), according to this analysis. The ODYSSEY OUTCOMES Investigators used patient-level data to assess the cost-effectiveness of alirocumab treatment over a…

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ODYSSEY ALTERNATIVE follow-up: Sustained LDL lowering in statin-intolerant patients

ODYSSEY ALTERNATIVE follow-up: Sustained LDL lowering in statin-intolerant patients

Follow-up over 3 years after the main ODYSSEY ALTERNATIVE trial showed that alirocumab treatment led to durable LDL cholesterol lowering and was safe in statin-intolerant patients. Before the advent of the PCSK9 inhibitors, attaining LDL cholesterol goal in patients unable to tolerate statin treatment was…

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No adverse effects of very low LDL cholesterol on cognition: further data from FOURIER

No adverse effects of very low LDL cholesterol on cognition: further data from FOURIER

Data from the entire 22,655-patient cohort of the FOURIER study provide further reassurance that the addition of the PCSK9 inhibitor evolocumab to maximally tolerated statin therapy did not impact patient-reported cognition. The safety of very low levels that are attainable with a PCSK9 inhibitor has…

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