Page 3 - Reflections_dyslipidaemia_newsletter4_2023

REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #4 2023

at two years, and 58% at three years, which may be due to
CLINICAL PEARLS FROM THE FACULTY the relatively low use of non-statin add-on therapy such as Dyslipidaemia
ezetimibe (20% in the treat-to-target group and 11% in the high-
intensity statin group at three years).

The results demonstrated here provide evidence supporting the
suitability of a treat-to-target strategy that may allow a tailored
approach with consideration for individual variability in drug
response to statin therapy.

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PROF. SHAWKY DISCUSS THE FOR THE LINK TO FULL ARTICLE
RELEVANCE OF THE RESULTS ON
CLINICAL PRACTICE.

Acute LDL-C reduction post ACS: Strike early and strike strong: From evidence
to clinical practice. A clinical consensus statement of the Association for Acute
CardioVascular Care (ACVC), in collaboration with the European Association of

Preventive Cardiology (EAPC) and the European Society of Cardiology Working
Group on Cardiovascular Pharmacotherapy.
Krychtiuk KA, et al. Eur Heart J Acute Cardiovasc Care. 2022;11(12):939-949.

Patients experiencing an ACS are at heightened risk of recurrent ischaemic CV events, especially in the very early phase. There is
a well-established relationship between lowering LDL-C and a reduction in CV events post-ACS, with the concept termed ‘the lower,
the better’. The ESC guidelines recommend a step-wise, lipid-lowering approach, but with assessments every four to six weeks; in
the best case scenario, it may take up to three months for a patient to achieve target goals, which coincides with the highest risk
period for recurrent CV events. The authors therefore propose a strategy of ‘strike early and strike strong’ with an immediate initiation
of combined lipid-lowering approach using high-intensity statins and ezetimibe. In patients with high-risk features, acute PCSK9

Expected effects of various lipid-lowering classes and their combination on LDL-C levels
Expected proportional LDL-C lowering
Drug class compared with placebo
Moderate-intensity statin 30%
High-intensity statin 50%
Ezetimibe 20%
PCSK9 antibody 60%
PCSK9 siRNA 50%
Bempedoic acid 15–25%
Combination therapy
High-intensity statin + ezetimibe 65%
High-intensity statin + PCSK9 antibody 75%
High-intensity statin + ezetimibe + PCSK9 antibody 85%
Bempedoic acid + ezetimibe 35%
Examples for high-intensity statins, defined as an expected LDL-C reduction of ~50%: atorvastatin 40–80 mg; rosuvastatin 20–40 mg. Examples for moderate-
intensity statins, commonly defined as an expected LDL-C reduction of 30 (−50)%: atorvastatin 10 (−20 mg); rosuvastatin (5−) 10 mg; simvastatin 20–40 mg; and
others. Available PCSK9 antibodies: alirocumab, evolocumab. Available PCSK9 siRNA: inclisiran. PCSK9, proprotein convertase subtilisin kexin-9; LDL-C, low-density
lipoprotein cholesterol; siRNA, small interfering ribonucleic acid.

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