LDL-C Targets in Secondary Prevention: How Low Should We Go?
<h3>Abstract</h3><p dir="ltr">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 w...
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| مؤلفون آخرون: | , , , , , , , |
| منشور في: |
2019
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| الموضوعات: | |
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| _version_ | 1864513567196184576 |
|---|---|
| author | Karim Bayoumy (3496688) |
| author2 | Mohammed Gaber (14151942) Preethi Mani (14151945) Rishi Puri (6090599) Eoin Donnellan (12122073) Leslie Cho (8859803) Donald Clark (14151948) Seth S. Martin (8164878) Mohamed B. Elshazly (14151951) |
| author2_role | author author author author author author author author |
| author_facet | Karim Bayoumy (3496688) Mohammed Gaber (14151942) Preethi Mani (14151945) Rishi Puri (6090599) Eoin Donnellan (12122073) Leslie Cho (8859803) Donald Clark (14151948) Seth S. Martin (8164878) Mohamed B. Elshazly (14151951) |
| author_role | author |
| dc.creator.none.fl_str_mv | Karim Bayoumy (3496688) Mohammed Gaber (14151942) Preethi Mani (14151945) Rishi Puri (6090599) Eoin Donnellan (12122073) Leslie Cho (8859803) Donald Clark (14151948) Seth S. Martin (8164878) Mohamed B. Elshazly (14151951) |
| dc.date.none.fl_str_mv | 2019-06-18T21:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1007/s12170-019-0619-8 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/LDL-C_Targets_in_Secondary_Prevention_How_Low_Should_We_Go_/21597657 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Clinical guidelines LDL lowering Secondary prevention PCSK9 inhibitors Adverse effects |
| dc.title.none.fl_str_mv | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <h3>Abstract</h3><p dir="ltr">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? </p><h3>Recent Findings</h3><p dir="ltr">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.</p><h3>Summary</h3><p dir="ltr">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.</p><h2>Other Information</h2><p dir="ltr">Published in: Current Cardiovascular Risk Reports<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="http://dx.doi.org/10.1007/s12170-019-0619-8" target="_blank">http://dx.doi.org/10.1007/s12170-019-0619-8</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_6f31dd42bddb72b73e1c4d56b1170135 |
| identifier_str_mv | 10.1007/s12170-019-0619-8 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/21597657 |
| publishDate | 2019 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | LDL-C Targets in Secondary Prevention: How Low Should We Go?Karim Bayoumy (3496688)Mohammed Gaber (14151942)Preethi Mani (14151945)Rishi Puri (6090599)Eoin Donnellan (12122073)Leslie Cho (8859803)Donald Clark (14151948)Seth S. Martin (8164878)Mohamed B. Elshazly (14151951)Biomedical and clinical sciencesCardiovascular medicine and haematologyPharmacology and pharmaceutical sciencesClinical guidelinesLDL loweringSecondary preventionPCSK9 inhibitorsAdverse effects<h3>Abstract</h3><p dir="ltr">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? </p><h3>Recent Findings</h3><p dir="ltr">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.</p><h3>Summary</h3><p dir="ltr">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.</p><h2>Other Information</h2><p dir="ltr">Published in: Current Cardiovascular Risk Reports<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="http://dx.doi.org/10.1007/s12170-019-0619-8" target="_blank">http://dx.doi.org/10.1007/s12170-019-0619-8</a></p>2019-06-18T21:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1007/s12170-019-0619-8https://figshare.com/articles/journal_contribution/LDL-C_Targets_in_Secondary_Prevention_How_Low_Should_We_Go_/21597657CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/215976572019-06-18T21:00:00Z |
| spellingShingle | LDL-C Targets in Secondary Prevention: How Low Should We Go? Karim Bayoumy (3496688) Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Clinical guidelines LDL lowering Secondary prevention PCSK9 inhibitors Adverse effects |
| status_str | publishedVersion |
| title | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| title_full | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| title_fullStr | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| title_full_unstemmed | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| title_short | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| title_sort | LDL-C Targets in Secondary Prevention: How Low Should We Go? |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Pharmacology and pharmaceutical sciences Clinical guidelines LDL lowering Secondary prevention PCSK9 inhibitors Adverse effects |