The year in cardiology 2017: prevention
█ Current opinion
Authors:
Børge G. Nordestgaard1*, Francesco Cosentino2, Ulf Landmesser3, and Ulrich Laufs4
1Department of Clinical Biochemistry and The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
2Cardiology Unit, Department of Medicine, Karolinska University Hospital, Solna, Stockholm, Sweden
3Department of Cardiology, Charite Universitätsmedizin Berlin, Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Hindenburgdamm 30, 12203 Berlin, Germany
4Klinik und Poliklinik für Kardiologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig, Leipzig, Germany
* Corresponding author:
Preamble
During 2017 several landmark studies have been published that have practical implications for atherosclerotic cardiovascular disease (ASCVD) prevention and risk factor control, such as lipids and lipoproteins, inflammation, diabetes, hypertension, and healthy lifestyle. We use the term “ASCVD” where relevant to simplify the reading of this article for the non-specialist, although the exact definition as ASCVD differ slightly from study to study. However, in sections where ASCVD clearly is not the relevant endpoint (e.g. in hypertension research) we do not use “ASCVD”, but instead of use other words to describe endpoints. All relevant trials have been performed on a background of optimal medical therapy, such as described in the European Society of Cardiology(ESC)/European Atherosclerosis Society(EAS) guidelines on ASCVD prevention and management of dyslipidaemia for lipid-lowering (1, 2). For example, important new evidence for additional risk reduction relates to lipid-lowering [proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition (3), cholesteryl ester transfer protein (CETP) inhibition] (4) to the reduction of systemic inflammation (interleukin-1β inhibition) (5) and to anti-thrombotic therapy (low-dose factor Xa antagonism) (6). Since these novel treatments have not yet been tested in combination and because of the practical and economic limitations, an important challenge for the years to come is patient selection. Also, the benefit to risk dimension of any new therapeutic agent needs to be considered. This review article is intended to provide the practicing physician with the information needed to identify patients in secondary prevention that may benefit the most from additional novel treatments (Figure 1), and at the same time give a comprehensive update of novel insights relevant both to primary and secondary prevention of ASCVD. Use and accessibility of novel treatments will depend critically on whether patients live in high income, upper middle-income or lower middle-income countries, as levels of cardiovascular risk factors, cardiovascular mortality rates, and thus the prevention potential differ between such countries (7).
ISSUE: CARDIOLOGIA HUNGARICA | 2018 | VOLUME 48, ISSUE 6
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