Background: Atherosclerotic cardiovascular diseases (ASCVD) including myocardial infarction, stroke and peripheral arterial disease continue to be major causes of premature death, disability and healthcare expenditure globally. Preventing the accumulation of cholesterol-containing atherogenic lipoproteins in the vessel wall is central to any healthcare strategy to prevent ASCVD. Advances in current concepts about reducing cumulative exposure to apolipoprotein B (apo B) cholesterol-containing lipoproteins and the emergence of novel therapies provide new opportunities to better prevent ASCVD. The present update of the World Heart Federation Cholesterol Roadmap provides a conceptual framework for the development of national policies and health systems approaches, so that potential roadblocks to cholesterol management and thus ASCVD prevention can be overcome.Methods: Through a review of published guidelines and research papers since 2017, and consultation with a committee composed of experts in clinical management of dyslipidaemias and health systems research in low-and-middle income countries (LMICs), this Roadmap identifies (1) key principles to effective ASCVD prevention (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMICs; and (4) potential strategies for overcoming these. 2 Ray et al.

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Background Monoclonal antibodies that inhibit the proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce low-density lipoprotein cholesterol (LDLc) by 55%, regardless of baseline treatments. Nonetheless, the effect of other lipid parameters, as cholesterol remnants or, the so-called residual lipid risk, are unknown. Methods Multicenter and retrospective registry of patients treated with PCSK9 inhibitors from 14 different hospitals from Spain. Before and on-treatment lipid parameters were recorded. Cholesterol remnants were calculated by the equation: total cholesterol minus LDLc minus HDLc and values ≥30 were considered high. Residual lipid risk was estimated by 1) the estimation of LDL particle size, by the triglycerides/HDLc ratio (TG/HDL) and values <2 were assumed as low and dense LDL particles; 2) total cholesterol/HDLc (TC/HDL) and values >3 were considered high; and; 3) the triglycerides-to-glucose (TG/Gluc) index, obtained as the natural logarithm of (triglycerides * glucose/2) Results A total of 652 patients were analyzed, mean age 60.0 (10.5) years and 161 (24.69%) women. Baseline LDLc was 149.2 (49.9) mg/dl, cholesterol remnants 29.9 (20.3) mg/dl, TG/HDL 3.9 (4.1), TC/HDL 4.9 (1.9) and TG/Gluc index 8.9 (0.7). Most patients (92.3%) were on statins; 54.8% with ezetimibe, 8.5% with fibrates. Evolocumab was initiated in 318 (56.6%) patients; 229 (40.7%) alirocumab 75 mg and 15 (2.7%) alirocumab 150 mg. Median time to second blood determination were 187.5 (IQR 101–242) days. Mean on-treatment LDLc was 67.46 (45.78) mg/dl what represented a 55% reduction. As shown in the figure, significant reduction in cholesterol remnants (p=0.017), TG/HDL ratio (p=0.020), TC/HDL ratio (p<0.001) and TG/Gluc index (p<0.001). The percentage of patients with remnants >30 mg/dl decreased: 34.62% to 30.07 (p<0.01). Significant reductions were also observed in the percentage of patients with TG/HDL >2 (71.25% to 61.98%; p<0.01) or TC/HDL >3 (94.28% to 38.97%; p<0.01) Conclusions This multicenter and retrospective registry of real-world patients treated with PCSK9 inhibitors demonstrates a positive effect on cholesterol remnants and lipid-residual risk beyond LDLc reductions. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: None. Introduction Patients with severe dyslipidemia (> 190 mg / dl) are considered in the clinical practice guidelines of high cardiovascular risk, therefore, diagnosis and treatment is essential, as well as the rest of the CV risk factors. But real-life records give us data of lack of control, justified by lack of adherence to treatment, underdiagnosis and therapeutic inertia among other factors. The aim of our work was to analyze patients knowledge about their dyslipidemia, treatment and the impact on their cardiovascular health. Materials and methods Patients with severe dyslipidemia (>190 mg/dl) from the familial hypercholesterolemia screening program were analyzed consecutively from February 1 – September 30, 2022. It was performed from Clinical Analysis, with an alarm system to detect severe dyslipidemia in people over 18 years of age in coordination with the Cardiovascular Prevention Unit of Cardiology and Genetics. All patients underwent a health questionnaire. Results n = 353. Mean age 52.2 years. 51.6% women (Table 1 baseline characteristics). 86.5% knew that they had dyslipidemia problems, mainly non-DM (85% vs 68%; p0.009), with familiy history (FH) of dyslipidemia (90% vs 81%;p 0.027) and older people (53.7 vs 47.1 years; p.001) But only 14.4% took treatment, patients with DM (31% vs. 13%; p0016), with FH of LDLhigh children (31% vs 12%; p 0.02), with personal history of CV disease (37% vs 13%; p 0.007) and BMI > 30 (20% vs 11%; p 0.017). 53.4% had taken treatment at some time, patients with hypertension (67% vs 49%;p 0.01), with family history of dyslipidemia (59% vs 44%; p 0.005), personal history of CV disease (87% vs 51%; p 0.005) and those over 40 years (55% vs 36%; p 0.016) 91.4% recognized the impact of dyslipidemia on the prognosis CV, mainly those with family history of dyslipidemia (94% vs 86%; p.017) and those under 40 years (100% vs 90.7%; p0.04). Conclusions A high percentage of patients recognize their dyslipidemia problem and the possible impact on their health, but less than 15% take lipid-lowering treatment.