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WHY TREAT-TO-TARGET LDL-C LEVELS (<1.8 MMOL/L) IN HIGH-RISK ASCVD CASES AND WHEN TO ESCALATE TREATMENT?1-3

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide.4,5 Atherosclerotic cardiovascular disease (ASCVD) occurs when low-density lipoprotein (LDL) particles move from the plasma into the subendothelial space of the arteries and accumulate, forming atherosclerotic plaques.1 Symptomatic ASCVD includes symptomatic coronary artery, cerebrovascular and peripheral arterial disease and can lead to cardiovascular events such as myocardial infarction and stroke.6

A patient’s atherosclerotic plaque burden is proportional to their cumulative lifetime exposure to LDL-C and other apo B-containing lipoproteins.1

Novartis Elevated LDL-C_v2

Elevated LDL-C is a major causal risk factor for ASCVD7

Novartis LDL-C reduction reduced risk_v2

LDL‐C reduction has been shown to reduce the risk of heart attack, stroke, and death7

Novartis vascular events decreases_v1

For every 1 mmol/L reduction in LDL-C the relative risk of major vascular events decreases by 22% over 5 years8

Atherosclerosis is a preventable disease.6 However, real-world evidence has shown that lipid levels are not adequately controlled, particularly in patients with established ASCVD who have a higher risk of cardiovascular disease (CVD).9,10 Of the high-risk patients taking recommended lipid-lowering therapy, almost half (48%) are not meeting LDL-C target <1.8mmol/L, and women, those with cerebrovascular disease and those who have had an event in the past 5 years are more likely to be sub-optimally treated.11

NOT ALL PATIENTS CAN ACHIEVE LDL-C TARGET WITH STATINS ALONE12

Adopting a healthy lifestyle and getting regular physical exercise is an important initial step towards lowering risk of ASCVD. However, many patients will also require medical therapies for sustained reductions in LDL-C.11 Importantly, early and sustained reductions in LDL-C are imperative to slow down or prevent disease progression.7 A combination of agents may also be required as not all patients can achieve LDL-C target on statins alone and may benefit from an add-on therapy.3

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Why I aim for low LDL-C

Professor Kausik Ray & Associate Professor Peter Psaltis

Lower, longer, earlier: the new LDL-C paradigm every doctor should be working towards

Associate Professor Adam Nelson

Why we need to look beyond the heart to identify patients with high-risk ASCVD?

Professor David Playford

ASCVD-Risk-Estimator-2

Help them understand their risk

Bookmark the AusCVD Risk Calculator.

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As GPs, what we can do to reduce mortality associated with ASCVD?

Dr Rob Hungerford

How can we overcome the limitations of the current standard of care for LDL-C

Professor Brendan McQuillen

Should Australia follow the European guidelines for LDL-C targets?

Professor John Amerena

Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; LDL-C, low-density lipoprotein cholesterol.

References: 1. Ference BA, et al. J Am Coll Cardiol 2018;72(23, Part B):2980–95. 2. Mach F, et al. Eur Heart J 2020;41(1):111-188. 3. Grundy SM, et al. J Am Coll Cardiol 2019;73(24):e285-e350.  4. Heron M. Natl Vital Stat Rep. 2019;68:1–77.2. 5. Herrington W, et al. Circ Res. 2016;118(4):535–546. 6. Makover ME, et al. Am J Prev Cardiol. 2022;12:100371. 7. Underberg J, et al. Postgrad Med. 2022;134(8):752-62. 8. Baigent C, et al. Lancet 2010;376(9753):1670–81. 9. Reiner Ž, et al. Atherosclerosis 2016;246:243–50. 10. Koskinas KC, et al. European Journal of Preventive Cardiology. 2021;28(18): 2030–37. 11. Baker IDI. Code Red: Overturning Australia’s cholesterol complacency. Accessed at https://www.baker.edu.au/-/media/documents/impact/baker-institute_code-red-report.pdf (last accessed March 2024). 12. Ray KK, et al. N Engl J Med. 2017; 376(15):1430-40.

AU-25078. March 2024.