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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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EVOLVD trial in heart transplant recipients

EVOLVD trial in heart transplant recipients

The Cholesterol lowering with EVOLocumab to prevent cardiac allograft Vasculopathy in De-novo heart transplant recipients (EVOLVD) trial (ClinicalTrials.gov Identifier: NCT03734211) aims to show whether treatment with evolocumab can ameliorate cardiac allograft vasculopathy (CAV) over the first year after heart transplant. Cardiac allograft vasculopathy is an…

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New FOURIER analysis supports aggressive LDL lowering in patients with a recent MI

New FOURIER analysis supports aggressive LDL lowering in patients with a recent MI

In this latest FOURIER analysis, add-on evolocumab treatment in patients with a recent myocardial infarction (MI) produced 3-fold greater absolute reduction in cardiovascular risk.  These findings confirm 2018 US guideline recommendations for adding a PCSK9 inhibitor in very high-risk patients with elevated LDL cholesterol (≥70…

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LDL cholesterol goals go even lower in India

LDL cholesterol goals go even lower in India

A statement from the Lipid Association of India proposes aggressive LDL cholesterol lowering for individuals at high and very high risk of cardiovascular disease. Cardiovascular disease (CVD) is now the leading cause of mortality in India, responsible for one-quarter of all deaths (1). A number…

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Does PCSK9 inhibition reduce the risk of venous thromboembolism?

Does PCSK9 inhibition reduce the risk of venous thromboembolism?

According to a new analysis from the FOURIER trial, a reduced risk of venous thromboembolism (VTE) is an additional benefit from PCSK9 inhibition in very high-risk patients. Lipoprotein(a) may be a key mediator of this effect. There are mixed observational data for a link between…

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ODYSSEY OUTCOMES – Alirocumab reduces risk for peripheral artery disease

ODYSSEY OUTCOMES – Alirocumab reduces risk for peripheral artery disease

A new analysis from ODYSSEY OUTCOMES shows that alirocumab treatment reduces the substantial risk of peripheral artery disease (PAD) in acute coronary syndrome (ACS) patients on intensive statin therapy. Reduction in lipoprotein(a), especially in individuals with high baseline levels, may mediate this benefit. In this…

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ODYSSEY KIDS: Alirocumab in children with heterozygous FH

ODYSSEY KIDS: Alirocumab in children with heterozygous FH

Alirocumab was effective in lowering LDL cholesterol in children and adolescents with heterozygous familial hypercholesterolaemia (FH, inherited high cholesterol) treated with a statin. Heterozygous FH is characterised by elevated levels of LDL cholesterol which, if untreated, lead to premature atherosclerosis and cardiovascular events (1). Yet,…

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Inclisiran in heterozygous familial hypercholesterolaemia

Inclisiran in heterozygous familial hypercholesterolaemia

Results from the ORION-9 study in patients with heterozygous familial hypercholesterolaemia (FH, inherited high cholesterol) show that inclisiran lowers LDL cholesterol by nearly 50% and is well tolerated. The advent of monoclonal antibodies directed against PCSK9 has revolutionised the management of FH, with proven efficacy…

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FH in the MENA region: Gulf Registry launched

FH in the MENA region: Gulf Registry launched

Preliminary data from the Gulf Familial Hypercholesterolaemia Registry (Gulf FH) show a high prevalence, with one in 232 people having definite or probable familial hypercholesterolaemia (FH, inherited high cholesterol). Heterozygous FH is largely underdiagnosed and undertreated.1 Information on prevalence is lacking in almost all countries,…

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Monogenic vs polygenic hypercholesterolaemia and cardiovascular risk

Monogenic vs polygenic hypercholesterolaemia and cardiovascular risk

Understanding the genetic cause of familial hypercholesterolaemia (FH, inherited high cholesterol) is imperative to better stratify and manage cardiovascular risk in patients, according to this report from the UK BioBank. FH is the most common inherited metabolic condition, affecting about one in 200-250 people.1 Genetic…

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