Journal article
Nonstatin Low-Density Lipoprotein-Lowering Therapy and Cardiovascular Risk Reduction-Statement From ATVB Council
Arteriosclerosis, thrombosis, and vascular biology, Vol.35(11), pp.2269-2280
11/2015
DOI: 10.1161/ATVBAHA.115.306442
PMCID: PMC4758700
PMID: 26376908
Abstract
Pharmacological reduction of low-density lipoprotein (LDL) cholesterol using statin drugs is foundational therapy to reduce cardiovascular disease (CVD) risk. Here, we consider the place of nonstatin therapies that also reduce LDL cholesterol in prevention of CVD. Among conventional nonstatins, placebo-controlled randomized clinical trials showed that bile acid sequestrants, niacin, and fibrates given as monotherapy each reduce CVD end points. From trials in which patients' LDL cholesterol was already well controlled on a statin, adding ezetimibe incrementally reduced CVD end points, whereas adding a fibrate or niacin showed no incremental benefit. Among emerging nonstatins, monoclonal antibodies against proprotein convertase subtilisin kexin type 9 added to a statin and given for ≤78 weeks showed preliminary evidence of reductions in CVD outcomes. Although these promising early findings contributed to the recent approval of these agents in Europe and in North America, much larger and longer duration outcomes studies are ongoing for definitive proof of CVD benefits. Other nonstatin agents recently approved in the United States include lomitapide and mipomersen, which both act via distinctive LDL receptor independent mechanisms to substantially reduce LDL cholesterol in homozygous familial hypercholesterolemia. We also address some unanswered questions, including measuring alternative biochemical variables to LDL cholesterol, evidence for treating children with monitoring of subclinical atherosclerosis, and potential risks of extremely low LDL cholesterol. As evidence for benefit in CVD prevention accumulates, we anticipate that clinical practice will shift toward more assertive LDL-lowering treatment, using both statins and nonstatins initiated earlier in appropriately selected patients.
Details
- Title: Subtitle
- Nonstatin Low-Density Lipoprotein-Lowering Therapy and Cardiovascular Risk Reduction-Statement From ATVB Council
- Creators
- Robert A Hegele - Western UniversitySamuel S Gidding - Alfred I. duPont Hospital for ChildrenHenry N Ginsberg - Columbia UniversityRuth McPherson - University of OttawaFrederick J Raal - University of the WitwatersrandDaniel J Rader - University of PennsylvaniaJennifer G Robinson - University of Iowa, EpidemiologyFrancine K Welty - Harvard Medical School
- Resource Type
- Journal article
- Publication Details
- Arteriosclerosis, thrombosis, and vascular biology, Vol.35(11), pp.2269-2280
- Publisher
- United States
- DOI
- 10.1161/ATVBAHA.115.306442
- PMID
- 26376908
- PMCID
- PMC4758700
- ISSN
- 1079-5642
- eISSN
- 1524-4636
- Grant note
- MOP-79523 / Canadian Institutes of Health Research R01 DE018184 / NIDCR NIH HHS R01 HL089945 / NHLBI NIH HHS P50 HL083813 / NHLBI NIH HHS R01 HL117933 / NHLBI NIH HHS MOP-13430 / Canadian Institutes of Health Research
- Language
- English
- Date published
- 11/2015
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9983995049202771
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