SHORT INTRO TO THE MYLAN SYMPOSIUM
A number of risk factors, cholesterol is key one, contribute to the development and progression of CVD and this is what is covered during this symposium.
Recent evidence confirms that exposure over time, years, to even mildly or moderately elevated levels of LDL-C determines the risk of future cardiovascular event.
Starting with early population strategies, the aim is to lower LDL-C based on lifestyle and the use in specific cases of nutraceuticals, such as Red Yeast Rice, leading to a moderate LDL-C reduction. If maintained over time this may result in significant reduction in CV event of these individuals 10-20 years later in their lives and should be implemented by health care systems to reduce CVD risk in large number of individuals.
Secondly, as practicing physicians, we now face more demanding targets for LDL-c lowering after an acute coronary syndrome, and a clear understanding of the pathophysiological rationale for these targets is important to improve our adherence to evidence-based recommendations. Several options for cholesterol lowering are currently available, and clinical studies demonstrate that combination therapy is increasingly required, but we need guidance on how to best combine the different drugs in order to achieve optimal reduction of cardiovascular risk. Consequently, after an acute coronary event, optimization of lipid lowering therapy before discharge and regular checks of LDL-c during follow up are important to reduce the risk of recurrent ischemic events, the next event being more likely to be fatal.
Finally, although LDL remains the therapeutic number 1 target, we nowadays have a clear, robust evidence that TG-rich lipoproteins containing Apo B and particularly their remnants are equally atherogenic on a per-particle basis as LDL. These lipoproteins significantly impact the residual risk of further CV events in patients with central obesity and/or type II diabetes even at low levels of LDL-C. In this setting, combinations of LDL and TG-rich lipoprotein lowering agents targeting all the Apo B containing lipoproteins could be the most effective reduction of CVD morbidity and mortality. The next step refers to advanced precision medicine where pharmacogenomics could open new perspectives.