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New European guidelines on dyslipidaemias highlights research in Australia

The Australian LDL cholesterol (LDL-C) targets in secondary prevention patients are being revisited in studies, following the recent publication of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on dyslipidaemias.

15 Nov 2019

The Australian LDL cholesterol (LDL-C) targets in secondary prevention patients are being revisited in studies, following the recent publication of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on dyslipidaemias.

For very-high risk patients in secondary prevention, the guidelines recommend a new LDL-C goal of <1.4 mmol/L and an LDL-C reduction of at least 50 per cent from baseline. For those with recurrent events within two years while taking maximally tolerated statin therapy, a goal of <1.0 mmol/L for LDL-C may be considered.

According to an article published in MJA Insight by clinical cardiologist and Professor of Medicine at Flinders University, Professor Philip Aylward, the Australian LDL-C targets for patients at high risk of cardiovascular events, should be revised to <1.4mmol/L to match the European guidelines.

“In Australia, various guidelines suggest a target of <1.8mmol/L for LDL-C for secondary prevention patients. However, the new target for patients post an ACS or otherwise at very high risk should be <1.4mmol/L,” Prof Aylward said.

“Mendelian randomisation studies have confirmed the critical role of LDL-C in atherosclerotic plaque formation and related subsequent cardiovascular events. Lowering LDL-C reduces cardiovascular events, including death, myocardial infarction (MI) and stroke. 

“To achieve an LDL-C target of <1.4mmol/L many patients will require not only high intensity statin and ezetimibe, but additional therapies. Currently an effective additional therapy is a PCSK9 inhibitor.”

One of the main updates since the 2016 European guidelines on dyslipidaemias, is the Class IA recommendation of PCSK9i therapy as secondary prevention. This recommendation is for patients at very high risk not achieving their LDL-C goal after 4-6 weeks of maximum tolerated dose of a statin and ezetimibe.

“The new European clinical guidelines represent a significant step forward in comparison to the previous guidelines,” Professor Aylward said.
The new guidelines are supported by data from Odyssey Outcomes, a multicentre, randomised, double-blind, placebo-controlled, treat-to-target trial assessing the effect of alirocumab versus placebo in 18,924 patients who had an acute coronary syndrome (ACS) 1 to 12 months (median 2.6 months) before randomisation.

 


Published: 15 Nov 2019