Arman Qamar1, Peter Libby2. 1. TIMI Study Group, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. 2. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 77 Ave Louis Pasteur, Boston, MA, 02115, USA. plibby@bwh.harvard.edu.
Abstract
PURPOSE OF REVIEW: Recent advances in low-density lipoprotein cholesterol (LDL-C) lowering therapy have now enabled reducing LDL-C safely to very low levels. This review summarizes evidence from recent randomized clinical trials of intensive LDL-C lowering in patients with acute coronary syndrome (ACS) and provides a practical approach for LDL-C lowering to reduce the risk of recurrent ischemic events in this population. RECENT FINDINGS: The risk of atherothrombotic events falls linearly with LDL-C level extending to very low achieved LDL-C levels (< 10 mg/dL) without apparent safety concerns. The addition of ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (i.e., evolocumab or alirocumab) to statin therapy lowers LDL-C to very low levels (≤ 30-50 mg/dL) with safety under the conditions studied and reduces the risk of recurrent cardiovascular events in patients with atherosclerotic cardiovascular disease. Current data support LDL-C lowering to levels below 70 mg/dL in patients post-ACS. Combination of high-intensity statins, ezetimibe, and if needed PCSK9 inhibitors merits consideration in such patients with ACS to optimize outcomes.
PURPOSE OF REVIEW: Recent advances in low-density lipoprotein cholesterol (LDL-C) lowering therapy have now enabled reducing LDL-C safely to very low levels. This review summarizes evidence from recent randomized clinical trials of intensive LDL-C lowering in patients with acute coronary syndrome (ACS) and provides a practical approach for LDL-C lowering to reduce the risk of recurrent ischemic events in this population. RECENT FINDINGS: The risk of atherothrombotic events falls linearly with LDL-C level extending to very low achieved LDL-C levels (< 10 mg/dL) without apparent safety concerns. The addition of ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (i.e., evolocumab or alirocumab) to statin therapy lowers LDL-C to very low levels (≤ 30-50 mg/dL) with safety under the conditions studied and reduces the risk of recurrent cardiovascular events in patients with atherosclerotic cardiovascular disease. Current data support LDL-C lowering to levels below 70 mg/dL in patients post-ACS. Combination of high-intensity statins, ezetimibe, and if needed PCSK9 inhibitors merits consideration in such patients with ACS to optimize outcomes.
Authors: G G Schwartz; A G Olsson; M D Ezekowitz; P Ganz; M F Oliver; D Waters; A Zeiher; B R Chaitman; S Leslie; T Stern Journal: JAMA Date: 2001-04-04 Impact factor: 56.272
Authors: Paul M Ridker; Christopher P Cannon; David Morrow; Nader Rifai; Lynda M Rose; Carolyn H McCabe; Marc A Pfeffer; Eugene Braunwald Journal: N Engl J Med Date: 2005-01-06 Impact factor: 91.245
Authors: Stephen D Wiviott; Christopher P Cannon; David A Morrow; Kausik K Ray; Marc A Pfeffer; Eugene Braunwald Journal: J Am Coll Cardiol Date: 2005-10-18 Impact factor: 24.094
Authors: James A de Lemos; Michael A Blazing; Stephen D Wiviott; Eldrin F Lewis; Keith A A Fox; Harvey D White; Jean-Lucien Rouleau; Terje R Pedersen; Laura H Gardner; Robin Mukherjee; Karen E Ramsey; Joanne Palmisano; David W Bilheimer; Marc A Pfeffer; Robert M Califf; Eugene Braunwald Journal: JAMA Date: 2004-08-30 Impact factor: 56.272
Authors: Scott M Grundy; James I Cleeman; C Noel Bairey Merz; H Bryan Brewer; Luther T Clark; Donald B Hunninghake; Richard C Pasternak; Sidney C Smith; Neil J Stone Journal: Circulation Date: 2004-07-13 Impact factor: 29.690
Authors: Christopher P Cannon; Eugene Braunwald; Carolyn H McCabe; Daniel J Rader; Jean L Rouleau; Rene Belder; Steven V Joyal; Karen A Hill; Marc A Pfeffer; Allan M Skene Journal: N Engl J Med Date: 2004-03-08 Impact factor: 91.245