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The PESA risk-factor-free cohort averaged 45 in age and 50.3% were women. They were evaluated at baseline for carotid, iliofemoral, and abdominal aortic plaques by ultrasound and coronary artery calcification by CT, and for a range of serum biomarkers and lifestyle measures.
Subclinical atherosclerosis, indicated by plaques or coronary calcification, was identified in 49.7% of the group and in more than one arterial system in 30%. The relationships between LDL-C and atherosclerosis presence and extent were seen in all arterial systems, Sanz said.
After the field's long-time success of statin therapy for primary and secondary prevention, the addition of drugs like ezetimibe and the PCSK9 inhibitors that can push LDL-C to below 50 mg/dL have shaken up traditional views of how contemporary drug therapy should be used for prevention of atherosclerotic cardiovascular disease (ASCVD), according to an editorial accompanying the report[2].
"In this context, the current analysis by Fernández-Friera et al is highly relevant and now raises the question of what the optimal cholesterol level may be in the primordial and primary prevention of ASCVD," write Dr Vijay Nambi (Baylor College of Medicine, Houston, TX) and Dr Deepak L Bhatt (Brigham and Women's Hospital, Boston, MA).
They speculate that "arterial imaging at an early age," perhaps supplemented by biomarker and genetic screening, "would help further refine and personalize risk assessment prior to the establishment of atherosclerosis and/or ASCVD." But there are no appropriate trials supporting that approach, they add.
Meanwhile, they write, "physicians should consider avoiding the term 'normal' and instead inform their patients of their current cholesterol, blood pressure, or blood glucose values and discuss what preventive efforts may be needed given their level of risk."
More here: https://www.medscape.com/viewarticle/890261#vp_2
Subclinical atherosclerosis, indicated by plaques or coronary calcification, was identified in 49.7% of the group and in more than one arterial system in 30%. The relationships between LDL-C and atherosclerosis presence and extent were seen in all arterial systems, Sanz said.
After the field's long-time success of statin therapy for primary and secondary prevention, the addition of drugs like ezetimibe and the PCSK9 inhibitors that can push LDL-C to below 50 mg/dL have shaken up traditional views of how contemporary drug therapy should be used for prevention of atherosclerotic cardiovascular disease (ASCVD), according to an editorial accompanying the report[2].
"In this context, the current analysis by Fernández-Friera et al is highly relevant and now raises the question of what the optimal cholesterol level may be in the primordial and primary prevention of ASCVD," write Dr Vijay Nambi (Baylor College of Medicine, Houston, TX) and Dr Deepak L Bhatt (Brigham and Women's Hospital, Boston, MA).
They speculate that "arterial imaging at an early age," perhaps supplemented by biomarker and genetic screening, "would help further refine and personalize risk assessment prior to the establishment of atherosclerosis and/or ASCVD." But there are no appropriate trials supporting that approach, they add.
Meanwhile, they write, "physicians should consider avoiding the term 'normal' and instead inform their patients of their current cholesterol, blood pressure, or blood glucose values and discuss what preventive efforts may be needed given their level of risk."
More here: https://www.medscape.com/viewarticle/890261#vp_2
