Following new European guidelines on dyslipidaemias – diseases characterised by abnormal levels of lipids in the blood – there has been a call to lower Australian LDL-cholesterol targets.
The Australian LDL-cholesterol (LDL-C) targets for secondary prevention patients are being called into question following the recent publication of the ‘European Society of Cardiology and European Atherosclerosis Society Guidelines on dyslipidaemias’.
Clinical cardiologist Professor Philip Aylward says he believes the Australian LDL-C targets for patients at high risk of cardiovascular events should be revised to <1.4mmol/L to match the European guidelines.
“In Australia, various guidelines suggest a target of <1.8mmol/L for LDL-C for secondary prevention patients,” he said. “However, the new target for patients post an ACS or otherwise at very high risk should be <1.4mmol/L.
“To achieve an LDL-C target of <1.4mmol/L many patients will require not only high intensity statin and ezetimibe, but also additional therapies. Currently an effective additional therapy is a PCSK9 inhibitor.”
The European guidelines on dyslipidaemias are a significant step forward compared with the previous guidelines of 2016.
They have broader recommendations for lowering LDL-C, including a focus beyond statin therapy and more intensive reduction of LDL-C across cardiovascular risk categories, based on safety and efficacy results from projects including the Fourier and Odyssey Outcomes trials.
The class IA recommends PCSK9i therapy as secondary prevention for patients at a very high risk not achieving their goal after four to five weeks of maximum tolerated dose of a statin and ezetimibe.
Odyssey Outcomes data supports new guidelines
The new guidelines are supported by data from Odyssey Outcomes, a multicentre, randomised, double-blind, placebo-controlled, treat-to target trial assessing the effect of Praluent (alirocumab) versus placebo in 18,924 patients who had an acute coronary syndrome one to 12 months (median 2.6 months) before randomisation.
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