期刊
EUROPEAN HEART JOURNAL
卷 42, 期 22, 页码 2154-2169出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehaa1080
关键词
Very low LDL-C levels; Cholesterol guidelines; PCSK9 inhibitors; Statins; Ezetimibe
资金
- AHA [19POST34400057]
- Abraham J & Phyllis Katz foundation
LDL-C is a causative factor for atherosclerotic cardiovascular disease, and pharmacological interventions can lower LDL-C levels. More patients are achieving very low LDL-C levels, with cardiovascular event reduction increasing log linearly in association with lowering LDL-C.
Low-density lipoprotein cholesterol (LDL-C) is a proven causative factor for developing atherosclerotic cardiovascular disease. Individuals with genetic conditions associated with lifelong very low LDL-C levels can be healthy. We now possess the pharmacological armamentarium (statins, ezetimibe, PCSK9 inhibitors) to reduce LDL-C to an unprecedented extent. Increasing numbers of patients are expected to achieve very low (<30 mg/dL) LDL-C. Cardiovascular event reduction increases log linearly in association with lowering LDL-C, without reaching any clear plateau even when very low LDL-C levels are achieved. It is still controversial whether lower LDL-C levels are associated with significant clinical adverse effects (e.g. new-onset diabetes mellitus or possibly haemorrhagic stroke) and longterm data are needed to address safety concerns. This review presents the familial conditions characterized by very low LDL-C, analyses trials with lipid-lowering agents where patients attained very low LDL-C, and summarizes the benefits and potential adverse effects associated with achieving very low LDL-C. Given the potential for cardiovascular benefit and short-term safe profile of very low LDLC, it may be advantageous to attain such low levels in specific high-risk populations. Further studies are needed to compare the net clinical benefit of non-LDL-C-lowering interventions with very low LDL-C approaches, in addition to comparing the efficacy and safety of very low LDL-C levels vs. current recommended targets. [GRAPHICS] .
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