Addressing residual risk beyond statin therapy: New targets in the management of dyslipidaemias-A report from the European Society of Cardiology Cardiovascular Round Table
- PMID: 39289123
- DOI: 10.1016/j.jacl.2024.07.001
Addressing residual risk beyond statin therapy: New targets in the management of dyslipidaemias-A report from the European Society of Cardiology Cardiovascular Round Table
Abstract
Cardiovascular (CV) disease is the most common cause of death in Europe. Despite proven benefits, use of lipid-lowering therapy remains suboptimal. Treatment goals are often not achieved, even in patients at high risk with atherosclerotic CV disease (ASCVD). The occurrence of CV events in patients on lipid-lowering drugs is defined as "residual risk", and can result from inadequate control of plasma lipids or blood pressure, inflammation, diabetes, and environmental hazards. Assessment of CV risk factors and vascular imaging can aid in the evaluation and management decisions for individual patients. Lifestyle measures remain the primary intervention for lowering CV risk. Where drug therapies are required to reach lipid treatment targets, their effectiveness increases when they are combined with lifestyle measures delivered through formal programs. However, lipid drug dosage and poor adherence to treatment remain major obstacles to event-free survival. This article discusses guideline-supported treatment algorithms beyond statin therapy that can help reduce residual risk in specific patient profiles while also likely resulting in substantial healthcare savings through better patient management and treatment adherence.
Keywords: Angiopoietin-like protein 3 (ANGPTL3); Antisense oligonucleotides (ASO); Apolipoprotein C-III (ApoCIII); Atherosclerotic cardiovascular disease (ASCVD); Familial hypercholesterolaemia; Lifestyle; Nutrition; Proprotein convertase subtilisin/kexin type 9 (PCSK9); Small interfering RNA (siRNA).
Copyright © 2024. Published by Elsevier Inc.
Conflict of interest statement
Declaration of competing interest Mach: Research grants from Amgen, Daiichi-Sankyo, Novartis, and Sanofi; participation on a data safety monitoring board or advisory board for Amgen, Daiichi-Sankyo, Novartis, and Sanofi. Visseren: None. Cater: Employment with and stock or stock options from Pfizer. Salhi: Employment with and stock or stock options from Amgen. Soronen: Employment with and stock or stock options from Daiichi Sankyo. Ray: Unrestricted institutional research grants from Amgen, Daiichi-Sankyo, Regeneron, and Sanofi; consulting fees for participation in a steering committee, executive committee, or advisory board for Novartis, Esperion, Daiichi Sankyo, Abbott, Bayer, Eli Lilly, Silence Therapeutics, CSL Behring, New Amsterdam Pharma, Sanofi, Amgen, Novo Nordisk, Boehringer Ingelheim, Scribe, Vaxxinity, CRISPR, AstraZeneca, Kowa Pharmaceuticals, Cargene Therapeutics; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events for CME and non-CME materials from Novartis, Novo Nordisk, Boehringer Ingelheim, AstraZeneca, Daiichi Sankyo, Amgen, Sanofi; leadership role (President) of European Atherosclerosis Society (EAS); and stock or stock options from Pemi-31 Therapeutics. Delgado: Consulting fees from Edwards Lifesciences, Novo Nordisk; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Abbott Vascular, Edwards Lifescience, GE Healthcare, Medtronic, Novartis, and Philips. Jukema: Research grants from and/or was speaker (with or without lecture fees) on CME accredited meetings sponsored by Amarin, Amgen, Athera, Biotronik, Boston Scientific, Dalcor, Daiichi-Sankyo, Lilly, Medtronic, Merck-Schering-Plough, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi Aventis, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute, and the European Community Framework KP7 Programme. Laufs: Support for the present manuscript from the European Society of Cardiology (ESC); grants or contracts from Amgen, Daiichi-Sankyo, and Novartis; consulting fees from Amgen, Boehringer Ingelheim, Daiichi-Sankyo, and Novartis; payment for public lectures from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi-Sankyo, Novartis, Novo Nordisk, Pfizer, and Sanofi; leadership roles with ESC, DGK, DACH, and EAS. Zamorano: Grants or contracts from Abbott and Edwards Lifesciences; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Bayer, Amgen, Daiichi-Sankyo, and Pfizer. Ros: Honoraria for a lecture at the Sociedad Española de Arteriosclerosis (SEA), for participation in an EAS Task Force Expert Panel on Dyslipidaemia Guidelines, for manuscript writing for the California Walnut Commission, and for participation in an educational seminar for the Fundación Dieta Mediterránea; and participation on an advisory board for Alexion. Plat: Travel reimbursement for the meeting relating to the present manuscript from the ESC; institutional grants from Raisio to evaluate effects of plant stanol esters on vaccinations; honoraria paid directly to the institution for lectures at the EAS 2020 annual meeting, the EAS 2021 annual meeting, and at the BASF Day of Science Symposium 2022. Gesztes: None. Tokgozoglu: Consulting fees Astra Zeneca, Abbott, Amgen, Bayer, MSD, Mylan, Novartis, Sanofi, Novo Nordisk, and Daiichi-Sankyo; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Abbott, Amgen, Daiichi-Sankyo, MSD, Mylan, Novartis, Novo Nordisk, Sanofi, Servier, Pfizer, Recordati, and Janssen; participation on a data safety monitoring board or advisory board for Abbott, Amgen, Novartis, Sanofi, Daiichi-Sankyo, Mylan, and Pfizer; and leadership roles with the EAS (past president) and Turkish Society of Cardiology (past president). Packard: Institutional research grant from Pfizer; consulting fees from Amgen, Amarin, Daiichi-Sankyo, MSD, Novartis, and Response therapeutics; and payment or honoraria for manuscript preparation from Novartis and for lectures for Amgen and Amarin. Libby: Support for the present manuscript from the National Heart, Lung, and Blood Institute (NHLBI) (grant nos. 1R01HL134892, 1R01HL163099-01), the American Heart Association (grant no. 18CSA34080399), the RRM Charitable Fund, and the Simard Fund; payment or honoraria for lectures and educational events from Pri-Med and Medtelligence; Research support from Novartis, Novo Nordisk, and Genentech, a US patent application for the use of canakinumab (application no. 20200239564) and a US provisional patent application for the treatment of brain ischemia-reperfusion injury (application no. 5409-0001); participation on a data safety monitoring board or advisory board for Amgen, Novartis, DalCor, and XBiotech, Inc; a leadership role (Director) for XBiotech, Inc; stock or stock options from XBiotech, Inc, TenSixteen Bio, and Soley Therapeutics; receipt of drugs from Novartis and Regeneron; consultancies (unpaid) for Amgen, Kowa Pharmaceuticals, Medimmune, AstraZeneca, Bain Institute, Beren Therapeutics, Esperion Therapeutics, Genentech, Merck, Moderna, Kancera, Novo Nordisk, Pfizer, Sanofi-Regeneron, participation on scientific advisory boards (unpaid) for Amgen, Kowa Pharmaceuticals, Olatec Pharmaceuticals, Medimmune, Caristo, Cartesian, CSL Behring, Dewpoint, Plaquetec, TenSixteen Bio, Soley Therapeutics, and Eulicid.
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