Determinants of Achieved LDL Cholesterol and “Non-HDL” Cholesterol in the Management of Dyslipidemias
Purpose of Review
The advent of combination therapy to provide LDL lowering beyond that achieved with statins necessitates the development of greater understanding of how drugs work together, what changes occur in key lipoprotein fractions, and what residual risk remains.
Clinical trials of agents that, when added to statins, generate profound LDL lowering have been successful in reducing further the risk of cardiovascular disease. LDL cholesterol can be now decreased to unprecedented levels, so the focus of attention then shifts to other apolipoprotein B-containing, atherogenic lipoprotein classes such as lipoprotein(a) and remnants of the metabolism of triglyceride-rich particles. “Non-HDL cholesterol” is used increasingly (especially if measured in the non-fasting state) as a more comprehensive index of risk.
Metabolic studies reveal how current drugs act in combination to achieve profound lipid lowering. However, care is needed in interpreting achieved LDLc and non-HDLc levels in the emerging treatment paradigm.
KeywordsLipoproteins CVD prevention Clinical trials Statin Ezetimibe PCSK9 inhibitors
Compliance with Ethical Standards
Conflict of Interest
Chris J. Packard reports grants/honoraria from the following pharmaceutical companies: Merck, Sharp & Dohme, Pfizer, Amgen, Sanofi, Regeneron, and Daiichi-Sankyo.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
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