Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy
Cardiovascular diseases (CVDs) are a leading global cause of mortality and are primarily driven by atherosclerotic coronary artery disease. Their pathogenesis involves multi-factorial mechanisms, among which low-density lipoprotein (LDL) plays a causative role. Recent ESC/EAS guidelines advocate for...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/13/7/1882 |
| _version_ | 1797212404732395520 |
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| author | Vincenzo Sucato Antonella Ortello Francesco Comparato Giuseppina Novo Alfredo Ruggero Galassi |
| author_facet | Vincenzo Sucato Antonella Ortello Francesco Comparato Giuseppina Novo Alfredo Ruggero Galassi |
| author_sort | Vincenzo Sucato |
| collection | DOAJ |
| description | Cardiovascular diseases (CVDs) are a leading global cause of mortality and are primarily driven by atherosclerotic coronary artery disease. Their pathogenesis involves multi-factorial mechanisms, among which low-density lipoprotein (LDL) plays a causative role. Recent ESC/EAS guidelines advocate for a shift toward new risk estimation algorithms that better emphasize non-fatal cardiovascular events, lifetime risk prediction, and tailored pharmacological approaches, including statin + ezetimibe and triple therapy, in specific cases. Intensive lipid-lowering therapy has been shown to be pivotal, especially in post-acute coronary events. Intracoronary imaging has revealed insights into the composition of plaque and demonstrated the significant regression that can be achieved through the use of statins such as rosuvastatin and atorvastatin. The positive effects of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors, particularly alirocumab and evolocumab, on plaque regression, have been demonstrated. Inclisiran, which targets PCSK9 gene expression, significantly reduces LDL cholesterol. The associated challenges include hesitancy to prescribe intensive regimens and limited treatment adherence, highlighting the need for pharmacological combinations to improve therapeutic outcomes. |
| first_indexed | 2024-04-24T10:41:51Z |
| format | Article |
| id | doaj.art-0369a329bd594a9cb76c724ea9739ba2 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-04-24T10:41:51Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0369a329bd594a9cb76c724ea9739ba22024-04-12T13:20:55ZengMDPI AGJournal of Clinical Medicine2077-03832024-03-01137188210.3390/jcm13071882Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical TherapyVincenzo Sucato0Antonella Ortello1Francesco Comparato2Giuseppina Novo3Alfredo Ruggero Galassi4Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, ItalyDivision of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, ItalyDivision of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, ItalyDivision of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, ItalyDivision of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90133 Palermo, ItalyCardiovascular diseases (CVDs) are a leading global cause of mortality and are primarily driven by atherosclerotic coronary artery disease. Their pathogenesis involves multi-factorial mechanisms, among which low-density lipoprotein (LDL) plays a causative role. Recent ESC/EAS guidelines advocate for a shift toward new risk estimation algorithms that better emphasize non-fatal cardiovascular events, lifetime risk prediction, and tailored pharmacological approaches, including statin + ezetimibe and triple therapy, in specific cases. Intensive lipid-lowering therapy has been shown to be pivotal, especially in post-acute coronary events. Intracoronary imaging has revealed insights into the composition of plaque and demonstrated the significant regression that can be achieved through the use of statins such as rosuvastatin and atorvastatin. The positive effects of Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) inhibitors, particularly alirocumab and evolocumab, on plaque regression, have been demonstrated. Inclisiran, which targets PCSK9 gene expression, significantly reduces LDL cholesterol. The associated challenges include hesitancy to prescribe intensive regimens and limited treatment adherence, highlighting the need for pharmacological combinations to improve therapeutic outcomes.https://www.mdpi.com/2077-0383/13/7/1882cardiovascular preventionlipid-lowering therapypolypillstatinezetimibePCSK9 monoclonal antibodies |
| spellingShingle | Vincenzo Sucato Antonella Ortello Francesco Comparato Giuseppina Novo Alfredo Ruggero Galassi Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy Journal of Clinical Medicine cardiovascular prevention lipid-lowering therapy polypill statin ezetimibe PCSK9 monoclonal antibodies |
| title | Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy |
| title_full | Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy |
| title_fullStr | Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy |
| title_full_unstemmed | Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy |
| title_short | Cholesterol-Lowering Strategies for Cardiovascular Disease Prevention: The Importance of Intensive Treatment and the Simplification of Medical Therapy |
| title_sort | cholesterol lowering strategies for cardiovascular disease prevention the importance of intensive treatment and the simplification of medical therapy |
| topic | cardiovascular prevention lipid-lowering therapy polypill statin ezetimibe PCSK9 monoclonal antibodies |
| url | https://www.mdpi.com/2077-0383/13/7/1882 |
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