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LDL-C: The Only Causal Risk Factor for ASCVD. Why Is It Still Overlooked and Underestimated?

  • Statin Drugs (R. Ceska, Section Editor)
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Abstract

Purpose of Review

Low-density lipoprotein cholesterol (LDL-C) is the most important causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This article reviews why LDL-C remains overlooked and underestimated despite numerous studies that have proved its role.

Recent Findings

Recently published EAS/ESC Guidelines for dyslipidemia and EAS Guidelines for prevention set new targets for LDL-C levels in primary and secondary prevention of ASCVD. These guidelines are based on data from large studies and meta-analyzes that have shown that lower LDL-C also means lower cardiovascular event rates. Real-life experience published in registries worldwide has shown us that the guidelines have not been translated to everyday clinical practice, meaning that a significant number of patients are undertreated and have LDL-C levels well above target. Potential reasons for the abovementioned are poor adherence and education of the patient and physician and health care system related factors.

Summary

Implementation of the latest version of guidelines will require continuous patient and physicians education, as well as a shared decision-making process between physician and patient.

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Authors and Affiliations

  1. Department for Internal Diseases and Hemodialysis, Cantonal Hospital Zenica, 72 000, Zenica, Bosnia and Herzegovina

    Lamija Ferhatbegović & Belma Pojskić

  2. Clinic for Internal Disease, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina

    Denis Mršić

  3. Medical Faculty Tuzla, University Clinical Center Tuzla, 75 000, Tuzla, Bosnia and Herzegovina

    Sabina Kušljugić

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  1. Lamija Ferhatbegović
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  2. Denis Mršić
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  4. Belma Pojskić
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Correspondence to Lamija Ferhatbegović.

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Conflict of Interest

Lamija Ferhatbegović reports payment or honoraria from KRKA FARMA d.o.o. Sarajevo, Bayer Pharma Sarajevo, Novartis Pharma Services Inc., and Servier. They also report support for attending meetings and/or travel from Farmavita Sarajevo and KRKA FARMA d.o.o. Sarajevo.

Denis Mršić reports payment or honoraria from Bosnalijek d.d Sarajevo.

Sabina Kušljugić has nothing to disclose.

Belma Pojskić reports payment or honoraria from KRKA FARMA d.o.o. Sarajevo, Lek d.d. Ljubljana, Novartis Pharma Services Inc., and Farmavita Sarajevo. They also report support for attending meetings and/or travel from Farmavita Sarajevo. And they report participation on a Data Safety Monitoring Board or Advisory Board for Novartis and Sanofi.

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This article is a review article in the field of low-density lipoprotein cholesterol and atherosclerotic cardiovascular disease. It contains previous publications based on human and animal studies.

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Ferhatbegović, L., Mršić, D., Kušljugić, S. et al. LDL-C: The Only Causal Risk Factor for ASCVD. Why Is It Still Overlooked and Underestimated?. Curr Atheroscler Rep 24, 635–642 (2022). https://doi.org/10.1007/s11883-022-01037-3

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