Still focusing on the bystander rather the the real problem.
Well shit, the whole problem is inflammation grabbing cholesterol out of the bloodstream and packing it into plaque. Cholesterol has never been the problem.
New cholesterol guidelines offer more personalized risk calculation, endorse nonstatin therapy
Cardiology Today, January 2019
New,
anticipated cholesterol guidelines from the American Heart Association,
American College of Cardiology and 10 other societies recommend a
stepped approach including treatment with statins, ezetimibe and PCSK9
inhibitors in patients with prior CVD at very high risk for another CV
event.
The updated guidance also calls for more personalized risk assessment than outlined in the previous version, which was published in 2013.
The guidelines are also notable for carving out a broader role for
coronary artery calcium scoring in patients in whom it is unclear
whether statin therapy should be initiated, returning LDL targets to
prominence in certain cases and adding emphasis on a heart-healthy
lifestyle, experts told Cardiology Today.
“I consider the 2018 cholesterol guidelines a step forward. They emphasize, as previous guidelines have done but perhaps in a more forward-thinking manner, the importance of a heart-healthy lifestyle,” Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine and Cardiology Today Editorial Board Member, said in an interview. “They build into their message not only adults who have high cholesterol but also young individuals to prevent the development of atherosclerotic CVD (ASCVD). Also of importance, many clinicians were somewhat dismayed and maybe confused by the lack of the 2013 cholesterol guidelines having goals or thresholds. But now, for specific patients, it helps clinicians target their specific therapies in a little more concrete manner, such as LDL lower than 70 mg/dL in high-risk patients and persons with diabetes.”
Steven E. Nissen, MD, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute and Cardiology Today Editorial Board Member, said the new guidelines address many of the shortcomings of the 2013 guidelines.
“The 2013 guidelines received a lot of criticism. What is interesting about the new guidelines is that they have addressed many of those concerns correctly and appropriately,” he told Cardiology Today. “The authors are bringing back the idea of LDL targets; you should not just give a statin and walk away. They are recommending more aggressive treatment of patients with LDL greater than 70 mg/dL, using add-ons of nonstatin therapies such as ezetimibe and PCSK9 inhibitors if necessary. That is a big step forward. Many of us have believed for quite some time that lower is better. The guidelines now acknowledge that.”
5 more pages at the link.
The updated guidance also calls for more personalized risk assessment than outlined in the previous version, which was published in 2013.
“I consider the 2018 cholesterol guidelines a step forward. They emphasize, as previous guidelines have done but perhaps in a more forward-thinking manner, the importance of a heart-healthy lifestyle,” Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine and Cardiology Today Editorial Board Member, said in an interview. “They build into their message not only adults who have high cholesterol but also young individuals to prevent the development of atherosclerotic CVD (ASCVD). Also of importance, many clinicians were somewhat dismayed and maybe confused by the lack of the 2013 cholesterol guidelines having goals or thresholds. But now, for specific patients, it helps clinicians target their specific therapies in a little more concrete manner, such as LDL lower than 70 mg/dL in high-risk patients and persons with diabetes.”
Steven E. Nissen, MD, chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute and Cardiology Today Editorial Board Member, said the new guidelines address many of the shortcomings of the 2013 guidelines.
“The 2013 guidelines received a lot of criticism. What is interesting about the new guidelines is that they have addressed many of those concerns correctly and appropriately,” he told Cardiology Today. “The authors are bringing back the idea of LDL targets; you should not just give a statin and walk away. They are recommending more aggressive treatment of patients with LDL greater than 70 mg/dL, using add-ons of nonstatin therapies such as ezetimibe and PCSK9 inhibitors if necessary. That is a big step forward. Many of us have believed for quite some time that lower is better. The guidelines now acknowledge that.”
Role of nonstatin therapies
These are the first guidelines to endorse ezetimibe and the PCSK9 inhibitors alirocumab (Praluent, Sanofi/Regeneron) and evolocumab (Repatha, Amgen) for use in certain patients, based on the results of the IMPROVE-IT, FOURIER and ODYSSEY OUTCOMES trials.5 more pages at the link.
No comments:
Post a Comment