JCL Roundtable: Rewriting the rules for primary prevention: New outcomes from intensive LDL-C reduction in high-risk patients

Abstract

This Journal of Clinical Lipidology Roundtable presents a conversation between Drs Robert P. Giugliano, Nicholas A. Marston, and Kevin C. Maki, who discussed clinical trials investigating intensive low-density lipoprotein cholesterol (LDL-C) reduction in high-risk patients. Their focus was on cardiovascular outcomes data from the recent Effect of Evolocumab in Patients at High Cardiovascular Risk Without Prior Myocardial Infarction or Stroke (VESALIUS-CV) trial, as well as earlier secondary prevention outcomes trials for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor monoclonal antibody agents: Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) and Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab (ODYSSEY Outcomes). In addition to comparing and contrasting the study designs, populations enrolled, and primary endpoint results between these primary and secondary prevention trials, the group also discussed high-risk subgroups and the important role of imaging in primary prevention, as well as the potential implications of recent trial findings on guideline recommendations for LDL-C treatment goals. Their conversation emphasized 2 themes demonstrated in recent data: (1) the importance of aggressively treating LDL-C earlier, and (2) the benefits in high-risk primary prevention of reducing LDL-C to lower levels than those recommended in current guidelines.