TY - JOUR
T1 - LDL-C Targets in Secondary Prevention
T2 - How Low Should We Go?
AU - Bayoumy, Karim
AU - Gaber, Mohammed
AU - Mani, Preethi
AU - Puri, Rishi
AU - Donnellan, Eoin
AU - Cho, Leslie
AU - Clark, Donald
AU - Martin, Seth S.
AU - Elshazly, Mohamed B.
N1 - Publisher Copyright:
© 2019, The Author(s).
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Purpose of Review: The benefits of lowering low-density lipoprotein cholesterol (LDL-C), mainly using high-intensity statin therapy, and its impact on decreasing the recurrence of atherosclerotic cardiovascular disease (ASCVD) in secondary prevention has been well established. With the advent of non-statin medications, particularly PCSK-9 inhibitors, which can lower LDL-C to very low levels not seen before, it is important to answer some important questions regarding LDL-C lowering and the uses of these medications in clinical practice: how low should we go with LDL-C reduction? Is there a threshold beyond which lower LDL-C is not associated with any benefit and possibly harm? Does the benefit derived from more aggressive LDL-C lowering justify the cost of additional therapies? Recent Findings: Our review has found overwhelming evidence to support the conclusion that lower achieved LDL-C levels correlate with a decreased burden of atherosclerosis and better clinical outcomes in secondary prevention. The concern for adverse effects with very low LDL-C levels is not backed by the literature, and side effects appear to be medication-specific. There still remains a question of the cost-effectiveness of some non-statin therapies particularly PCSK9 inhibitors, in spite of recent price decreases, and whether the benefit is worth the cost. Summary: It is prudent to always pursue an individualized patient-level approach to LDL-C lowering that considers the patient’s global cardiovascular risk, their side effect profile, and the cost-effectiveness of therapies in order to derive maximal benefit from aggressive lipid lowering.
AB - Purpose of Review: The benefits of lowering low-density lipoprotein cholesterol (LDL-C), mainly using high-intensity statin therapy, and its impact on decreasing the recurrence of atherosclerotic cardiovascular disease (ASCVD) in secondary prevention has been well established. With the advent of non-statin medications, particularly PCSK-9 inhibitors, which can lower LDL-C to very low levels not seen before, it is important to answer some important questions regarding LDL-C lowering and the uses of these medications in clinical practice: how low should we go with LDL-C reduction? Is there a threshold beyond which lower LDL-C is not associated with any benefit and possibly harm? Does the benefit derived from more aggressive LDL-C lowering justify the cost of additional therapies? Recent Findings: Our review has found overwhelming evidence to support the conclusion that lower achieved LDL-C levels correlate with a decreased burden of atherosclerosis and better clinical outcomes in secondary prevention. The concern for adverse effects with very low LDL-C levels is not backed by the literature, and side effects appear to be medication-specific. There still remains a question of the cost-effectiveness of some non-statin therapies particularly PCSK9 inhibitors, in spite of recent price decreases, and whether the benefit is worth the cost. Summary: It is prudent to always pursue an individualized patient-level approach to LDL-C lowering that considers the patient’s global cardiovascular risk, their side effect profile, and the cost-effectiveness of therapies in order to derive maximal benefit from aggressive lipid lowering.
KW - Adverse effects
KW - Clinical guidelines
KW - LDL lowering
KW - PCSK9 inhibitors
KW - Secondary prevention
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U2 - 10.1007/s12170-019-0619-8
DO - 10.1007/s12170-019-0619-8
M3 - Review article
AN - SCOPUS:85067518877
SN - 1932-9520
VL - 13
JO - Current Cardiovascular Risk Reports
JF - Current Cardiovascular Risk Reports
IS - 8
M1 - 23
ER -