UPDATE IN THE MANAGEMENT OF

DYSLIPIDEMIA 2013

RESDISUAL CV RISK AND SUBOPTIMAL

LDL-C REDUCTION BEYOND STATINS

J. Antonio G. López, MD FACC, FAHA, FACP, FACA, FCCP, FASE, FASA, FNLA, FASH

Fellow, Council on Clinical Cardiology, American Heart Association

Fellow, Council on Arteriosclerosis, Thrombosis, and Vascular Biology, American Heart Association

Fellow, Council on Epidemiology and Prevention, AHA

Overseas Fellow, Royal Society of Medicine

Specialist in Clinical Hypertension, American Society of Hypertension

Diplomate, American Board of Clinical Lipidology

Director, Preventive Cardiology and Cardiovascular Rehabilitation, Saint Alphonsus Regional Medical Center

Director, Lipid Clinic and LDL Apheresis Program, Saint Alphonsus Regional Medical Center

Chair, Department of Cardiology, Saint Alphonsus Regional Medical Center

Chair Cardiovascular Research and Education, Saint Alphonsus Regional Medical Center

President, Pacific Lipid Association

SAINT ALPHONSUS MEDICAL GROUP HEART CARE

Presenter Disclosure

Information

DISCLOSURE INFORMATION:

The following relationships exist related to this presentation

(consultant and/or speakers bureau):

J. Antonio G. López, M.D., F.A.C.C., F.A.H.A. ,F.A.C.P.,

F.A.C.A., F.C.C.P., F.A.S.E., F.A.S.A., F.N.L.A.

Abbott Laboratories

Aegerion Pharmaceuticals

Amarin

AstraZeneca

Boerhringer Ingelheim

Pharmaceuticals, Inc.

Bristol-Myers Squibb Company

Daiichi Sankyo, Inc.

Diadexus

Forest Pharmaceuticals

Gilead

GlaxoSmithKline

Kowa Pharmaceuticals America, Inc.

Preventive Diagnostics

Takeda Pharmaceuticals

ZonaHealth

Objectives

• Discuss the importance of intensive LDL-C lowering strategy for addressing residual

Cardiovascular(CV) risk despite current optimal medical therapy

• Review the current pathophysiologic rationale for PSCK( inhibition in

hypercholesterolemia via a discussion of the mechanism of action and an analysis of

emerging clinical data.

• Describe the potential impact of emerging LDL-C targeted therapies in patients who

require additional LDL-C reduction, such as, those with familial hypercholesterolemia

and statin intolerance.

• Provide Recommendations

12

What Is Desirable Cholesterol?

50 70 90 110 130 150 170 190 210

Adult American

San

Pygmy

!Kung

Inuit

Hazda

Hunter-

gatherer

humans

Mean total cholesterol, mg/dL

Cholesterol Levels Among Different Human

Populations

Adapted from O’Keefe JH Jr et al. J Am Coll Cardiol. 2004;43:2142–2146.

TREATMENT GOALS IN PATIENTS WITH

CMR AND LIPOPROTEIN ABNORMALITIES

HIGHEST RISK HIGH-RISK

• LDL <70 <100

• NON-HDL <100 <130

• APO B <80 <90

JACC 2008:51:1512-1524

Copyright ©2009 American College of Cardiology Foundation. Restrictions may apply.

Robinson, J. G. et al. J Am Coll Cardiol 2009;53:316-322

Change in Relative Risk of CHD Event

CHD Event Associations of NMR LDL Particle

Number (LDL-P) versus LDL Cholesterol (LDL-C)

Pro

babili

ty o

f E

vent-

free S

urv

ival

Years of Follow-up

Low LDL-C – High LDL-P

(n=282)

High LDL-C – High LDL-P

(n=1251)

High LDL-C – Low LDL-P

(n=284)

Low LDL-C – Low LDL-P

(n=1249)

Pro

babili

ty o

f E

vent-

free S

urv

ival

Years of Follow-up

Low LDL-C – High LDL-P

(n=282)

High LDL-C – High LDL-P

(n=1251)

High LDL-C – Low LDL-P

(n=284)

Low LDL-C – Low LDL-P

(n=1249)

Pro

babili

ty o

f E

vent-

free S

urv

ival

Years of Follow-up

Low LDL-C – High LDL-P

(n=282)

High LDL-C – High LDL-P

(n=1251)

High LDL-C – Low LDL-P

(n=284)

Low LDL-C – Low LDL-P

(n=1249)

Pro

babili

ty o

f E

vent-

free S

urv

ival

Years of Follow-up

Low LDL-C – High LDL-P

(n=282)

High LDL-C – High LDL-P

(n=1251)

High LDL-C – Low LDL-P

(n=284)

Low LDL-C – Low LDL-P

(n=1249)

Cromwell WC et al: J Clinical Lipidology 2007;1:583-592

Effects of eicosapentaenoic acid on major coronary events in

hypercholesterolaemic patients (JELIS): a randomised open-label,

blinded endpoint analysis

Mitsuhiro Yokoyama, MD, Hideki Origasa, PhD, Masunori Matsuzaki, MD, Yuji Matsuzawa, MD, Yasushi Saito, MD, Yuichi

Ishikawa, MD, Shinichi Oikawa, MD, Jun Sasaki, MD, Hitoshi Hishida, MD, Hiroshige Itakura, MD, Toru Kita, MD, Akira Kitabatake,

MD, Noriaki Nakaya, MD, Toshiie Sakata, MD, Kazuyuki Shimada, MD, Kunio Shirato, MD and for the Japan EPA lipid intervention

study (JELIS) Investigators

The Lancet

Volume 369, Issue 9567, Pages 1090-1098 (March 2007) DOI: 10.1016/S0140-6736(07)60527-3

Copyright © 2007 Elsevier Ltd Terms and Conditions

Predictions for ATP-IV

1. The goals for LDL-C in primary prevention will be lowered.

2. There will be a stronger statement on hsCRP, but routine use in risk stratification or use as secondary target will not be specifically endorsed.

3. Non-HDL-C will remain the secondary lipid target, but optional use of apo B or LDL-P will be endorsed.

4. A new risk calculator providing lifetime risk estimates will be provided.

Questions?