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Is There a Need to Revise Goals in the Management of Dyslipidemias?

Current Cardiology Reports volume 21, Article number: 51 (2019) Cite this article

Abstract

Purpose of Review

Current guidelines on the management of patients with dyslipidemias recommend specific risk-dependent low-density lipoprotein cholesterol (LDL-C) treatment goals. Recently, several randomized clinical trials have investigated further lowering of LDL-C in addition to statin therapy using novel therapeutic approaches and examined their effects on cardiovascular (CV) risk. This review summarizes newly available data on efficacy and safety of lowering LDL-C beyond statin therapy and below current treatment targets.

Recent Findings

In patients at very high risk for CV events, a significant residual risk remains when failing to achieve significant LDL-C reduction on maximally tolerated statin therapy alone. Further lowering of LDL-C, even beyond current treatment targets, has been shown to be safe and was associated with a further reduced CV risk reduction. The relative risk reduction per change in LDL-C levels has been observed to be consistent even in patient populations achieving extremely low levels of LDL-C.

Summary

In patients at very high CV risk, further lowering of LDL-C beyond statin therapy and present treatment targets has been observed to further reduce CV risk, which may be foremost relevant for patients at a particular high absolute CV risk, e.g., for patients with progressive and/or very extensive coronary disease.

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Author information

Affiliations

  1. Department of Cardiology, Charité – University Medicine Berlin (Campus Benjamin Franklin), Hindenburgdamm 30, 12203, Berlin, Germany

    David Sinning & Ulf Landmesser

  2. Berlin Institute of Health (BIH), Berlin, Germany

    Ulf Landmesser

  3. German Centre for Cardiovascular Research (DZHK), Berlin, Germany

    Ulf Landmesser

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  1. David Sinning
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  2. Ulf Landmesser
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DS and UL contributed to the conception or design of the work. DS drafted the manuscript. UL critically revised the manuscript. Both gave final approval and agree to be accountable for all aspects of work ensuring both integrity and accuracy.

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Correspondence to Ulf Landmesser.

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Conflict of Interest

David Sinning has received lecture honoraria or advisory honoraria from Amgen, Sanofi, and Berlin-Chemie. Ulf Landmesser has received lecture or advisory honoraria from Amgen, Sanofi, Medicines Company, and Berlin-Chemie.

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Sinning, D., Landmesser, U. Is There a Need to Revise Goals in the Management of Dyslipidemias?. Curr Cardiol Rep 21, 51 (2019). https://doi.org/10.1007/s11886-019-1128-6

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Keywords

  • Dyslipidemia
  • Low-density lipoprotein cholesterol
  • Treatment goals
  • Statins
  • Ezetimibe
  • PCSK9 inhibitors