Page 6 - reflections_dyslipidaemia_newsletter5_2023

REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #5 2023

Clinically, low HDL-C remains an important risk marker for
increased risk of ASCVD. For patients with extremely high CLINICAL PEARLS FROM THE FACULTY Dyslipidaemia
HDL-C, the documented increased risk of infectious disease and
all-cause mortality could inform patients and physicians on the
negative prognostic consequences of high HDL-C. The authors
suggest that future efforts to pharmacologically modulate HDL
should focus on HDL function rather than HDL-C levels and
other clinical indications besides ASCVD.

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WATCH
DR. WELNICKI DISCUSS THE
CLINICAL RELEVANCE OF HDL TO
EVERYDAY PRACTICE.

TREATMENT

Great debate: Lipid-lowering therapies should be guided by vascular imaging
rather than by circulating biomarkers.

Tokgozoglu L, et al. Eur Heart J. 2023 Jul 1;44(25):2292-2304.

Current guidelines recommend initiation and intensification of lipid-lowering therapies based on LDL-C levels of the individual, along
with total cardiovascular risk level. With an increasing number of lipid-lowering therapies, the authors explain that it is important to
better understand in whom, when, and how to administer these therapies optimally. In this review article, the authors present the
evidence for and against the statement that lipid-lowering therapies should be guided by vascular imaging rather than by circulating
biomarkers.

On the Pro side, the authors suggest that identifying primary prevention patients with the greatest benefit of use of more intensive
lipid lowering remains uncertain and that vascular imaging, such as computed tomography coronary angiography (CTCA) to calculate
coronary calcium scores may be beneficial. Non-invasive vascular imaging has the potential to identify subclinical atherosclerotic
disease and recognize patients that may benefit from intensified therapies to reduce their cardiovascular risk. The authors review
several studies in support of this and conclude that since an atherosclerotic plaque is what causes an ischaemic event, the ability to
identify those plaques with imaging allows for an ideal opportunity to treat them.

On the Con side, the authors discuss that imaging approaches are costly and that data from randomized trials are needed to
demonstrate incremental value of vascular imaging to target therapeutic strategies for lipid lowering. Currently available biomarkers
that are correlated with increased CV risk, such as high-sensitivity CRP, systolic BP, total cholesterol, and non-HDL cholesterol, are
inexpensive to measure, can be obtained during a routine patient visit without exposure of the patient to radiation, and may be used
in combination to further stratify moderate-risk patients who do not otherwise qualify for lipid-lowering therapies.

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