LDL cholesterol target achievement in heterozygous familial hypercholesterolemia patients according to 2019 ESC/EAS lipid guidelines: Implications for newer lipid-lowering treatments

Rizos, C.; Skoumas, Ioannis; Rallidis, Lοukianos S.; Skalidis, Emmanouil; Τζιόμαλος, Κωνσταντίνος; Garoufi, Anastasia; Anagnostis, Panagiotis; Sfikas, George; Kotsis, Vasilios; Doumas, Michalis; Kolovou, Genovefa; Lambadiari, Vaia; Dima, Ioanna; Kiouri, E.; Zacharis, E.; Agapakis, D.; Attilakos, Achilleas; Antza, Christina; Vlachopoulos, Charalambos; Liberopoulos, Evangelos

doi:10.1016/j.ijcard.2021.10.024

Cited by 21 publications

(21 citation statements)

References 32 publications

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“…Our results are in accordance with other studies evaluating LDL-C target achievement in FH patients [16]. It was shown that the LDL-C target was achieved only in 5.9% of patients [17]. As a result, a significant percentage of patients (55.9%) would be eligible for iPCKS9 treatment.…”

Section: Discussionsupporting

confidence: 92%

“…As a result, a significant percentage of patients (55.9%) would be eligible for iPCKS9 treatment. However, even after the addition of iPCKS9 42.4% of patients may still fail to reach LDL-C targets, so, they would thus qualify for a 4th hypolipidemic drug, like bempedoic acid and angiopoietinlike protein 3 (ANGPTL3) inhibitors [17]. In our data 37.5% of FH patients will need a 4th hypolipidemic drug or lipoprotein apheresis, respectively.…”

Section: Discussionmentioning

confidence: 71%

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Can Recently Recommended Target Levels for LDLCholesterol and Lipoprotein(a) Be Reached by Using Intensive Lipid-Lowering Therapy Including Lipoprotein Apheresis ?

Alekseevna¹,

Yurievna²,

Julius³

2022

MPCVM

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Targets for LDL-cholesterol (LDL-C) that should be aimed at have been defined by international societies. In high-risk patients they are set at 1.8 (70 mg/dL) and 1.4 mmol/L (55 mg/dL). We report our experience with respect to the use of statin and PCSK9 inhibitors in patients with familial hypercholesterolemia (FH). It was observed that in 37.5% of FH patients the target LDL-C level, corresponding to the risk category, was not achieved.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 71%

Can Recently Recommended Target Levels for LDLCholesterol and Lipoprotein(a) Be Reached by Using Intensive Lipid-Lowering Therapy Including Lipoprotein Apheresis ?

Alekseevna¹,

Yurievna²,

Julius³

2022

MPCVM

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“…The combination of high intensity statin, ezetimibe, and PCSK9 inhibitor is potentially able to reduce LDL-C by 85% compared to baseline values, allowing the achievement of the therapeutic target in most cases ( Table 1 ). In the real world, however, it is clear that more than 80% of patients who require therapy with cholesterol-lowering drugs for either primary or secondary prevention of cardiovascular diseases do not reach the targets set in the 2019 guidelines ( 5 , 6 ). Failure to achieve those targets is associated to a significant increase in the number of cardiovascular events in the whole population.…”

Section: Introductionmentioning

confidence: 99%

Mechanism of action and therapeutic use of bempedoic acid in atherosclerosis and metabolic syndrome

Biolo

Vinci

Mangogna

et al. 2022

Front. Cardiovasc. Med.

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Bempedoic acid is a new cholesterol-lowering drug, which has recently received US FDA and EMA approval. This drug targets lipid and glucose metabolism as well as inflammation via downregulation of ATP-citrate lyase and upregulation of AMP-activated protein kinase (AMPK). The primary effect is the reduction of cholesterol synthesis in the liver and its administration is generally not associated to unwanted muscle effects. Suppression of hepatic fatty acid synthesis leads to decreased triglycerides and, possibly, improved non-alcoholic fatty liver disease. Bempedoic acid may decrease gluconeogenesis leading to improved insulin sensitivity, glucose metabolism, and metabolic syndrome. The anti-inflammatory action of bempedoic acid is mainly achieved via activation of AMPK pathway in the immune cells, leading to decreased plasma levels of C-reactive protein. Effects of bempedoic acid on atherosclerotic cardiovascular disease, type 2 diabetes and chronic liver disease have been assessed in randomized clinical trials but require further confirmation. Safety clinical trials in phase III indicate that bempedoic acid administration is generally well-tolerated in combination with statins, ezetimibe, or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to achieve low-density lipoprotein cholesterol targets. The aim of this narrative review on bempedoic acid is to explore the underlying mechanisms of action and potential clinical targets, present existing evidence from clinical trials, and describe practical management of patients.

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“…Based on the new European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines most patients with familial hypercholesterolemia currently do not reach the LDL-C target values even on a maximal dosage of statin/ ezetimibe. Many patients are candidates for PCSK9 inhibitor therapy, and a considerable number of patients would require apheresis to reach target lipid levels [13].…”

Section: Discussionmentioning

confidence: 99%

Precision Medicine Approach for Cardiometabolic Risk Factors in Therapeutic Apheresis

Yin

Takov

Straube³

et al. 2022

Horm Metab Res

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Lipoprotein apheresis (LA) is currently the most powerful intervention possible to reach a maximal reduction of lipids in patients with familial hypercholesterolemia and lipoprotein(a) hyperlipidemia. Although LA is an invasive method, it has few side effects and the best results in preventing further major cardiovascular events. It has been suggested that the highly significant reduction of cardiovascular complications in patients with severe lipid disorders achieved by LA is mediated not only by the potent reduction of lipid levels but also by the removal of other proinflammatory and proatherogenic factors. Here we performed a comprehensive proteomic analysis of patients on LA treatment using intra-individually a set of differently sized apheresis filters with the INUSpheresis system. This study revealed that proteomic analysis correlates well with routine clinical chemistry in these patients. The method is eminently suited to discover new biomarkers and risk factors for cardiovascular disease in these patients. Different filters achieve reduction and removal of proatherogenic proteins in different quantities. This includes not only apolipoproteins, C-reactive protein, fibrinogen, and plasminogen but also proteins like complement factor B (CFAB), protein AMBP, afamin, and the low affinity immunoglobulin gamma Fc region receptor III-A (FcγRIIIa) among others that have been described as atherosclerosis and metabolic vascular diseases promoting factors. We therefore conclude that future trials should be designed to develop an individualized therapy approach for patients on LA based on their metabolic and vascular risk profile. Furthermore, the power of such cascade filter treatment protocols may improve the prevention of cardiometabolic disease and its complications.

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LDL cholesterol target achievement in heterozygous familial hypercholesterolemia patients according to 2019 ESC/EAS lipid guidelines: Implications for newer lipid-lowering treatments

Cited by 21 publications

References 32 publications

Can Recently Recommended Target Levels for LDLCholesterol and Lipoprotein(a) Be Reached by Using Intensive Lipid-Lowering Therapy Including Lipoprotein Apheresis ?

Can Recently Recommended Target Levels for LDLCholesterol and Lipoprotein(a) Be Reached by Using Intensive Lipid-Lowering Therapy Including Lipoprotein Apheresis ?

Mechanism of action and therapeutic use of bempedoic acid in atherosclerosis and metabolic syndrome

Precision Medicine Approach for Cardiometabolic Risk Factors in Therapeutic Apheresis

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