Latest news with #LDLcholesterol
Medscape
10-07-2025
- Health
- Medscape
What Is Lp(a), and When Should We Check It?
In this podcast, I'm going to talk about what we need to know about lipoprotein (a), or Lp(a), and atherosclerotic cardiovascular disease in primary care. Lp(a) is an important but underappreciated independent risk factor for atherosclerotic cardiovascular disease. As we all know, atherosclerotic cardiovascular disease is a chronic, progressive condition characterized by the accumulation of lipids, inflammatory cells, and other cells in arteries that results in the formation of atherosclerotic plaques. As these plaques build up and rupture, they cause partial or complete obstruction of blood flow, tragically leading to clinical events such as myocardial infarctions or ischemic strokes. I'm sure all of us in primary care can sadly recall individuals who have suffered heart attacks or strokes who appeared to be very healthy, with no obvious cardiovascular risk factors. We all know that elevated LDL cholesterol levels (or bad cholesterol) are a proven and direct cause of atherosclerotic cardiovascular disease, and it has been estimated that for each 1 mmol/L reduction in LDL cholesterol, there's a relative risk reduction of 23% for major cardiovascular events. Well, Lp(a) is an LDL-like particle that is an independent, genetically determined risk factor for major cardiovascular events and cardiovascular mortality. But unlike LDL cholesterol, Lp(a) levels are not significantly affected by lifestyle choices or statins. Lp(a) is found in atherosclerotic plaques and has proinflammatory, prothrombotic, and proatherogenic effects driving that progression of atherosclerosis. Epidemiological and genetic studies strongly support a causal and continuous association between Lp(a) levels and cardiovascular outcomes. In fact, Lp(a) is a risk factor even at very low levels of LDL cholesterol. Lp(a) is also an independent risk factor for calcific aortic stenosis. So, how common are elevated Lp(a) levels? Well, around 1 in 5 people globally are at high risk of developing atherosclerotic cardiovascular disease due to elevated Lp(a) levels. However, there are differences with regard to Lp(a) levels across different ethnicities. Black individuals are more likely to have elevated Lp(a) than White, Hispanic, or Asian individuals. Importantly, Lp(a) levels are inherited in a predominantly autosomal dominant manner, which means a child of an affected parent with high Lp(a) levels has a 50% chance of being affected him- or herself. So, what levels of Lp(a) drive an increased risk of atherosclerotic cardiovascular disease? Levels of 32-90 nmol/L confer a minor risk. Levels between 90 and 200 nmol/L confer a moderate risk. Levels of 200-400 nmol/L confer a high risk, and levels greater than 400 nmol/L confer a very high risk. Lp(a) levels need to only be measured once in a lifetime, unless a specific treatment is being undertaken to lower levels, which I will discuss shortly. Heart UK, the UK cholesterol charity, published a consensus statement and call to action on Lp(a) during 2019 that included some useful, pragmatic recommendations for all of us working in primary care. Notably, this consensus gave a number of recommendations on when we should consider checking Lp(a) levels. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease, particularly under the age of 60 years. We should consider checking levels in those with a first-degree relative with high Lp(a) levels over 200 nmol/L. We should consider checking levels in those with a history of familial hypercholesterolemia or another genetic dyslipidemia. We should consider checking levels in those with a background of calcific aortic valve stenosis. And we should also consider checking levels in those with a borderline increased 10-year cardiovascular risk of around about 10% to 15%. This is to aid reclassification of these individuals at intermediate risk of atherosclerotic cardiovascular disease and hopefully encourage acceptance of LDL cholesterol-lowering therapies such as statins. So, how do we manage elevated Lp(a) levels? Currently, there are no approved therapies to treat elevated Lp(a) levels. The most effective therapy for high Lp(a) levels is apheresis, which is a blood filtering process like dialysis. This procedure is reserved for the highest risk individuals, as it is very expensive, requires weekly visits to the apheresis center, and is not without harm. However, newer therapies targeting Lp(a) directly are in development, which will transform the management of high-risk individuals. So, what can we do meanwhile in primary care for those with high Lp(a) levels? We need to mitigate overall cardiovascular risk with aggressive lipid management and targeting of all other cardiovascular risk factors. For those with Lp(a) levels greater than 90 nmol/L (moderate risk and above), we should initiate a high-intensity statin and aim for a greater than 50% reduction in non-HDL cholesterol and an LDL cholesterol of less than 1.8 mmol/L liter or non-HDL cholesterol level of less than 2.5 mmol/L. We should also consider referral to a specialist lipid clinic for those with high-risk Lp(a) levels (greater than 200 nmol/L) but manage all cardiovascular risk factors while waiting for them to be seen. Cascade screening and family should also be offered to individuals with a familial or personal history of high Lp(a) levels or an early history of atherosclerotic cardiovascular disease in the family under the age of 60 years. So, a call to action for us all in primary care: Lp(a) is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease that is not significantly affected by lifestyle choices or statins. We should consider checking Lp(a) levels in those with a personal or family history of premature atherosclerotic cardiovascular disease under the age of 60 years, in those with calcific aortic valve stenosis, or in those where an atherosclerotic event has occurred with no obvious underlying risk factors. Finally, I produced a Medscape UK primary care hack or clinical aide-mémoire on lipid management for the primary and secondary prevention of cardiovascular disease for healthcare professionals. I hope you find this resource helpful. Medscape Family Medicine © 2025 WebMD, LLC Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape. Cite this: What Is Lp(a), and When Should We Check It? - Medscape - Jul 10, 2025.
Medscape
17-06-2025
- Health
- Medscape
Is This Drug a Statin Alternative?
Monotherapy with inclisiran — an injectable small interfering RNA that targets hepatic proprotein convertase subtilisin/kexin type 9 (PCSK9) — reduced levels of low-density lipoprotein (LDL) cholesterol more effectively than placebo or ezetimibe in patients at a low-to-borderline risk for atherosclerotic cardiovascular disease who were not receiving any lipid-lowering therapy, with a favorable safety profile. METHODOLOGY: Previous studies have shown the efficacy of inclisiran in lowering the level of LDL cholesterol when used in combination with statins in patients with a high risk for atherosclerosis; however, its efficacy as a monotherapy without statins remains uncertain. Researchers conducted a 6-month multinational, randomized, phase 3 study to compare the efficacy and safety of inclisiran with those of placebo or ezetimibe in reducing levels of LDL cholesterol. They included 350 participants (mean age, 46.1 years; 62.6% women) with no history of atherosclerotic cardiovascular disease , diabetes, or familial hypercholesterolemia and a fasting LDL cholesterol level of 100-190 mg/dL. Participants were randomly assigned to receive subcutaneous inclisiran (n = 174), oral ezetimibe (n = 89), or matching placebo (n = 87), with inclisiran administered on days 1 and 90. The primary endpoint was the percentage change in the level of LDL cholesterol from baseline to day 150; several secondary endpoints, including the absolute change in LDL and safety, were assessed. TAKEAWAY: By day 150, participants who received inclisiran showed a 47.9% greater reduction in the level of LDL cholesterol than those who received placebo and a 35.4% greater reduction than those who received ezetimibe ( P < .0001 for both). < .0001 for both). The absolute reduction in the level of LDL cholesterol and the percentage reduction in PCSK9 levels were also greater in participants who received inclisiran than in those who received placebo or ezetimibe ( P < .0001 for all). < .0001 for all). In the group who received inclisiran, levels of lipoprotein(a) decreased by 25.2% compared with placebo ( P = .001) and by 24.3% compared with ezetimibe ( P = .0002) by day 150. = .001) and by 24.3% compared with ezetimibe ( = .0002) by day 150. Similar rates of treatment-emergent adverse events were noted across the three groups, with no new safety concerns. IN PRACTICE: 'There is a significant unmet clinical need for therapies that address both statin intolerance and adherence in primary prevention,' the researchers noted. 'Inclisiran is potentially uniquely positioned to meet these challenges owing to its first-in-class mechanism of action, favorable safety profile, and infrequent twice-yearly dosing,' they added. SOURCE: This study was led by Pam R. Taub, MD, of the University of California in San Diego. It was published online on June 9, 2025, in Journal of the American College of Cardiology . LIMITATIONS: A short follow-up duration and limited sample size prevented the researchers from evaluating the cardiovascular outcomes of lowering the level of LDL cholesterol with inclisiran. The analysis lacked direct comparison with statins, anti-PCSK9 monoclonal antibodies, or bempedoic acid. The response of LDL with ezetimibe was lower than that observed in other studies. DISCLOSURES: This study received funding from Novartis Pharma. Two authors reported receiving compensation for serving as principal investigators of this trial, and another author reported serving as a consultant for multiple pharmaceutical companies including the funding agency. Several other authors reported serving as employees of the US or Switzerland wings of the funding agency or being principal investigator, consultants, and/or holding shares in the same.
Yahoo
07-06-2025
- Health
- Yahoo
Adding This One Berry to Your Breakfast Slashes LDL Cholesterol, According to Cardiologists
Adding This One Berry to Your Breakfast Slashes LDL Cholesterol, According to Cardiologists originally appeared on Parade. By now, you probably know the basics of a heart-healthydiet: lots of vegetables, plenty of fruit, some whole grains, healthy fats and a bit of lean meat or fish, with minimal processed foods and limited amounts of trans fats, cholesterol and said, while all fruit is good for you (unless, obviously, you have allergies to any of them!), not all fruits are created equal, nutritionally speaking. There's one specific berry variety that really warms the hearts of cardiologists for its LDL cholesterol-lowering benefits. What is it and why is it so fabulous, particularly for breakfast? Read on to find out.🩺SIGN UP for tips to stay healthy & fit with the top moves, clean eats, health trends & more delivered right to your inbox twice a week💊 This is one time when having the blues is a good thing."As a cardiologist, I regularly recommend blueberries to my patients as part of a heart-healthy diet," , director of cardiology at John F. Kennedy University Medical Center in New Jersey, tells Parade. "These small but mighty berries are nutritional powerhouses packed with anthocyanins, the compounds that give them their deep blue color. Research consistently shows that people who consume blueberries regularly have improved cardiovascular outcomes. For patients with elevated LDL levels, I often suggest incorporating a cup of fresh or frozen blueberries into their daily routine as part of a comprehensive approach to cholesterol management." "Clinical studies indicate that regular blueberry consumption can lead to modest improvements in total cholesterol levels," Dr. Feingold continues. "More importantly, blueberries appear to help optimize the ratio between good HDL cholesterol and harmful LDL cholesterol. The anti-inflammatory properties of blueberries also play a role, as chronic inflammation can negatively affect cholesterol metabolism and cardiovascular health. The research on blueberries and LDL cholesterol is particularly encouraging. Several well-designed studies have shown that consuming blueberries regularly can lead to meaningful reductions in LDL cholesterol levels, typically in the range of 5% to 15% when consumed as part of a balanced diet."Dr. Feingold isn't alone in his love for blueberries. , board-certified internist, cardiologist, interventional cardiologist and professor of cardiology at New York Medical College, gives more insight into how they may reduce LDL "The fiber in blueberries helps the body eliminate (or not absorb) certain cholesterol, leading to reduced circulating levels," he says. "One randomized placebo-controlled study showed that six months of blueberry consumption improved 'good' cholesterol, known as HDL cholesterol, and improved blood vessel relaxation."Similar studies have so far indicated improvements in HDL ("good") cholesterol, which in some ways is more powerful than reducing the bad cholesterol of LDL, Dr. Naidu continues. "Nonetheless, as HDL rises, LDL is increasingly cleared and thus LDL, or 'bad,' cholesterol may also be reduced. Increasing HDL is very difficult to do with medications alone, which is a good reason to supplement with fruits that may do this, such as blueberries." That said, no food is miraculous, so don't think you can sub these tasty morsels for medication that your cardiologist or physicians prescribe to you. "Particularly in those at great cardiovascular risk or with metabolic syndrome, consistent intake of blueberries usually helps the body's lipid profile—especially when combined with a diet low in refined sweets and saturated fats," , cardiologist and founder of Manhattan Cardiology and co-founder of LabFinder, advises. "It has been established that blueberries can reduce oxidized LDL. They may also assist in modifying the form of LDL particles, which helps to reduce the likelihood that these particles may develop atherosclerosis. Still, it's important to clear the common belief that 'natural foods' could replace medications, including statins."Related: Let's be clear: No matter when you eat blueberries, you'll see health benefits. However, noshing on them for your first meal of the day may be even better than snacking on them later on."While blueberries are beneficial any time of day, there are several reasons why morning consumption with breakfast may be optimal," Dr. Feingold says. "First, starting the day with antioxidant-rich foods helps establish a foundation of cardiovascular protection that can last throughout the day. More practically, having blueberries with breakfast often means pairing them with other heart-healthy foods like oatmeal, Greek yogurt or whole grain cereals. This combination enhances the absorption of nutrients and provides sustained energy release, helping to stabilize blood sugar levels throughout the morning. Additionally, many people find it easier to maintain consistent healthy habits when they're incorporated into morning routines."Dr. Feingold adds, "The fiber in blueberries helps slow the absorption of other breakfast foods, preventing rapid spikes in blood glucose that can stress the cardiovascular system."Related: Lower LDL cholesterol isn't the only punch these bad boys pack when it comes to cardiovascular benefits. Blueberries benefit basically your entire body, not just your heart, no matter when you consume them."The most important factor is consistency. Whether you enjoy blueberries at breakfast, as an afternoon snack, or in an evening smoothie, the key is making them a regular part of your diet," Dr. Feingold says. "The cardiovascular benefits come from sustained, long-term consumption rather than the specific timing of when you eat them."Related: Antioxidants are good for fighting cellular aging and inflammation and are particularly beneficial to brain health. Cardiologists we spoke to specifically pointed to the anthocyanins in blueberries as bringing serious antioxidant benefits that you may not find in other berry varieties."Antioxidants help prevent LDL cholesterol from becoming oxidized," Dr. Feingold says. "Oxidized LDL is particularly dangerous because it's more likely to form plaques in arterial walls. By reducing both the quantity of LDL cholesterol and preventing its oxidation, blueberries provide a double benefit for cardiovascular protection.""The antioxidants in blueberries help reduce inflammation throughout the cardiovascular system," he Dr. Naidu explains that some studies have shown blueberries improve nitric oxide production, which can, in turn, boost brain and vascular health and potentially prevent stroke."Nitric oxide is a naturally occurring relaxant of blood vessels, and this function may underlie the overall heart and brain health benefits seen in patients," he notes. "In addition to lowering blood pressure, nitric oxide makes the blood vessels resistant to plaque buildup and blockage development.""Studies have demonstrated that regular blueberry consumption can improve blood vessel function, reduce arterial stiffness and support healthy blood pressure levels," Dr. Feingold tells Parade. "For my patients looking to make simple dietary changes that benefit their heart, adding a serving of blueberries daily is one of the easiest recommendations I can make."Related: If part of your heart health journey involves weight loss, blueberries are a great choice to add to your diet: Dr. Naidu points out that not only are they rich in fiber, which will keep you feeling fuller for longer, but a full cup of blueberries is only about 80 calories. Up Next:Dr. Aaron Feingold, MD Dr. Srihari S. Naidu, MD, FACC, FAHA, FSCAI Dr. Robert Segal, MD Adding This One Berry to Your Breakfast Slashes LDL Cholesterol, According to Cardiologists first appeared on Parade on Jun 6, 2025 This story was originally reported by Parade on Jun 6, 2025, where it first appeared.
Medscape
27-05-2025
- General
- Medscape
Achieving LDL Cholesterol Goals in Statin-Resistant Patients
High levels of LDL cholesterol (LDL-C) can lead to the development and progression of atherosclerotic cardiovascular disease and increase the risk for major cardiovascular events. Statins have long been used as first-line therapy to lower LDL-C. However, some patients are unable or unwilling to take statin therapy. Dr Ann Marie Navar, from the University of Texas Southwestern Medical Center, discusses alternative treatment options for these patients, including the oral medication ezetimibe, which is well tolerated and affordable; however, ezetimibe lowers LDL-C by only 15%-20%. Dr Navar also discusses newer therapies, including the injectable monoclonal antibody PCSK9 inhibitors evolocumab and alirocumab. Both are dosed about every 2 weeks and have been shown to reduce LDL-C by more than 50% in clinical trials. Another PCSK9 inhibitor is the first-in-class siRNA inclisiran, a long-acting therapy that is given every 6 months after an initial loading dose that is followed by a second dose at 3 months. Inclisiran is effective at lowering LDL-C, yet clinical data on its cardiovascular outcomes are not yet available. The final option Dr Navar discusses is the oral therapy bempedoic acid, which is available as monotherapy or combined with ezetimibe as a single pill. The combination lowers LDL-C levels by 35%-40%. As monotherapy, says Dr Navar, bempedoic acid is slightly less effective.
