Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk

Domanski, Michael J.; Tian, Xin; Wu, Colin O.; Reis, Jared P.; Dey, Amit; Gu, Yuan; Zhao, Lihui; Bae, Sejong; Liu, Kiang; Hasan, Ahmed; Zimrin, David; Farkouh, Michael E.; Hong, Charles C.; Lloyd‐Jones, Donald M.; Fuster, Valentín

doi:10.1016/j.jacc.2020.07.059

Cited by 210 publications

(142 citation statements)

References 28 publications

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“…2). The importance of reducing LDL-C has been further underscored by a recent prospective study on 4958 asymptomatic adults evaluating the relationship among the incidence of ASCVD event risk, the cumulative exposure to LDL-C, and the time course of LDL-C accumulation [119]. However, moving to real-life, there is a gap between clinical guidelines and clinical practice, an evidence underscored by the recent DA VINCI study, an 18 country, cross-sectional, observational study of patients prescribed lipid-lowering therapies for primary and secondary care across Europe [120••].…”

Section: Discussionmentioning

confidence: 99%

Lipid Lowering Drugs: Present Status and Future Developments

Ruscica

Ferri

Santos

et al. 2021

Curr Atheroscler Rep

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Purpose of review Based on the recent data of the DA VINCI study, it is clear that, besides utilization of statins, there is a need to increase non-statin lipid lowering approaches to reduce the cardiovascular burden in patients at highest risk. Recent findings For hypercholesterolemia, the small synthetic molecule bempedoic acid has the added benefit of selective liver activation, whereas inclisiran, a hepatic inhibitor of the PCSK9 synthesis, has comparable effects with PCSK9 monoclonal antibodies. For hypertriglyceridemia, cardiovascular benefit has been achieved by the use of icosapent ethyl, whereas results with pemafibrate, a selective agonist of PPAR-α, are eagerly awaited. In the era of RNA-based therapies, new options are offered to dramatically reduce levels of lipoprotein(a) (APO(a)LRX) and of triglycerides (ANGPTL3LRX and APOCIII-LRx). Summary Despite the demonstrated benefits of statins, a large number of patients still remain at significant risk because of inadequate LDL-C reduction or elevated blood triglyceride-rich lipoproteins or lipoprotein(a). The area of lipid modulating agents is still ripe with ideas and major novelties are to be awaited in the next few years.

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Section: Discussionmentioning

confidence: 99%

Lipid Lowering Drugs: Present Status and Future Developments

Ruscica

Ferri

Santos

et al. 2021

Curr Atheroscler Rep

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“…Patients with FH are at high risk for premature CVD, attributable not only to the degree of elevation in atherogenic lipoprotein cholesterol levels, but also because of the cumulative lifetime exposure to increased LDL-C levels. [120] Management of HeFH includes aggressive cholesterol lowering at an early age, usually involving statin therapy. [121] Statins are the most recommended drug treatment for hypercholesterolemia due to their cholesterol-lowering efficacy, safety, and CVD benefits supported by numerous CVD outcomes trials.…”

Section: Dyslipidemiamentioning

confidence: 99%

Section: Dyslipidemiamentioning

confidence: 99%

Ten things to know about ten cardiovascular disease risk factors

Bays

Taub

Epstein

et al. 2021

American Journal of Preventive Cardiology

130

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Given rapid advancements in medical science, it is often challenging for the busy clinician to remain up-to-date on the fundamental and multifaceted aspects of preventive cardiology and maintain awareness of the latest guidelines applicable to cardiovascular disease (CVD) risk factors. The “American Society for Preventive Cardiology (ASPC) Top Ten CVD Risk Factors 2021 Update” is a summary document (updated yearly) regarding CVD risk factors. This “ASPC Top Ten CVD Risk Factors 2021 Update” summary document reflects the perspective of the section authors regarding ten things to know about ten sentinel CVD risk factors. It also includes quick access to sentinel references (applicable guidelines and select reviews) for each CVD risk factor section. The ten CVD risk factors include unhealthful nutrition, physical inactivity, dyslipidemia, hyperglycemia, high blood pressure, obesity, considerations of select populations (older age, race/ethnicity, and sex differences), thrombosis/smoking, kidney dysfunction and genetics/familial hypercholesterolemia. For the individual patient, other CVD risk factors may be relevant, beyond the CVD risk factors discussed here. However, it is the intent of the “ASPC Top Ten CVD Risk Factors 2021 Update” to provide a succinct overview of things to know about ten common CVD risk factors applicable to preventive cardiology.

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“…13 Previous study proposed that the causal effect of LDL-C on the risk of cardiovascular disease is determined by both the magnitude and the cumulative duration of exposure to these lipoproteins. 14 Additionally, the UK Biobank study demonstrated the association between long-term exposure to lower levels of LDL-C and with lower risks of cardiovascular events, in a dose-dependent way. 15 Stroke remains the leading cause of disability and mortality worldwide.…”

Section: Introductionmentioning

confidence: 99%

Cumulative burden of lipid profiles predict future incidence of ischaemic stroke and residual risk

Dai

Zhang

et al. 2021

Stroke Vasc Neurol

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ObjectivesIncident ischaemic stroke (IS) risk may increase not only with lipids concentration but also with longer duration of exposure. This study aimed to investigate the impact of cumulative burden of lipid profiles on risk of incident IS.MethodsA total of 43 836 participants were enrolled who participated in four surveys during 2006–2013. Individual cumulative lipid burden was calculated as number of years (2006–2013) multiplied by the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglyceride (TG), respectively. The primary outcome was defined as the incident IS during 2012–2017.ResultsDuring 4.67 years (±0.70 years) follow-up on average, we identified 1023 (2.33%) incident IS. Compared with respective reference groups, the HRs (95% CIs) of the upper tertile in cumulative TG burden, cumulative LDL-C burden, cumulative TC burden and cumulative non-HDL-C burden were 1.26 mmol/L (1.02–1.55 mmol/L), 1.47 mmol/L (1.25–1.73 mmol/L), 1.33 mmol/L (1.12–1.57 mmol/L) and 1.51 mmol/L (1.28–1.80 mmol/L) for incidence of IS, respectively. However, this association was not significant in cumulative HDL-C burden and IS (HR: 1.09; 95% CI: 0.79 to 1.52), after adjustment for confounding variables. Among 16 600 participants with low cumulative LDL-C burden, HRs (95% CI) for TC, TG, non-HDL-C and HDL-C with IS were 1.63 mmol/L (1.03–2.57 mmol/L), 1.65 mmol/L (1.19–2.31 mmol/L), 1.57 mmol/L (1.06–2.32 mmol/L) and 0.98 mmol/L (0.56–1.72 mmol/L), respectively.ConclusionsWe observed the correlation between cumulative burden of lipid profiles, except for cumulative burden of HDL-C, with the risk of incident IS. Cumulative burden of TC, TG and non-HDL-C may still predict IS in patients with low cumulative LDL-C burden.Trial registration numberChiCTR-TNRC-11001489.

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Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk

Cited by 210 publications

References 28 publications

Lipid Lowering Drugs: Present Status and Future Developments

Lipid Lowering Drugs: Present Status and Future Developments

Ten things to know about ten cardiovascular disease risk factors

Cumulative burden of lipid profiles predict future incidence of ischaemic stroke and residual risk

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