Below is a summary of a recent interview with Professor Michal Vrablik. The reading time is approximately 5 minutes.

<h2>Key Takeaways</h2>
<ul>
 <li>Preventive cardiology focuses on distinguishing between severe and less severe coronary atherosclerosis.</li>
 <li>A new scoring system helps identify individuals with higher plaque burden and more severe stenosis.</li>
 <li>Premature death from acute heart attacks remains a significant threat, with a high mortality rate.</li>
 <li>Atherosclerosis is a systemic disease affecting multiple vascular beds, including cerebrovascular and peripheral arteries.</li>
 <li>Screening for risk factors like arterial hypertension and dyslipidemia, especially elevated LDL-C, is crucial.</li>
 <li>Systematic screening should be done at every opportunity, particularly for those with a positive family history or at-risk age.</li>
 <li>Atherosclerosis develops due to a cluster of risk factors acting simultaneously, necessitating aggressive treatment.</li>
 <li>Modern imaging methods like CT angiography and calcium scoring improve risk estimates and early identification of at-risk individuals.</li>
</ul>

Watch the video here or read the summary below:

DYSLIPIDEMIA

CARDIOLOGY

Preventive Cardiology: Key Insights from Professor Michal Vrablik

In a recent interview, Professor Michal Vrablik, who works at the General University Hospital and First Faculty of Medicine of Charles University in Prague, shared his expertise in preventive cardiology. He explained that this field focuses on distinguishing between severe and less severe coronary atherosclerosis. A newly developed scoring system helps identify individuals with a higher plaque burden and more severe stenosis, which is crucial for targeted prevention strategies.

Professor Vrablik emphasized that premature death from acute heart attacks remains a major threat, with a significant mortality rate. He noted that atherosclerosis is a systemic disease that affects multiple vascular beds, including cerebrovascular and peripheral arteries, leading to various severe consequences if left untreated.
To prevent the first cardiovascular event, thorough screening of risk factors is essential. Professor Vrablik highlighted the importance of identifying common risk factors such as arterial hypertension and dyslipidemia, particularly elevated levels of LDL-Cholesterol (LDL-C). He stressed that lipid screening should be performed at every opportunity, especially for individuals with a positive family history or those at an age where risk increases.

Atherosclerosis develops due to a cluster of risk factors acting simultaneously on the vessel walls. Therefore, it is crucial to search for and treat these metabolic and cardiovascular abnormalities aggressively. This is particularly important for patients with insulin resistance, metabolic syndrome, and type 2 diabetes, who are at the highest risk of atherosclerotic complications.
Professor Vrablik also pointed out that atherosclerosis is often asymptomatic, making systematic screening vital for early detection. Modern imaging methods, such as CT angiography and calcium scoring of coronary arteries, enhance the precision of risk estimates and help identify at-risk individuals before atherosclerosis fully develops.

In conclusion, Professor Vrablik's insights highlight the importance of preventive cardiology, systematic screening, and&nbsp;aggressive treatment of risk factors to manage and reduce the burden of cardiovascular diseases effectively.

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Below is a summary of a recent interview with Professor Pasquale Perrone-Filardi. The reading time is approximately 5 minutes.

<h2>Key Takeaways</h2>
<ul>
 <li>LDL-Cholesterol (LDL-C) is the most critical risk factor for atherosclerotic disease, a leading cause of death and illness worldwide.</li>
 <li>Reducing LDL-C is essential for preventing cardiovascular diseases across all risk categories.</li>
 <li>The ESC/EAS guidelines provide clear targets and recommendations for managing cardiovascular risk.</li>
 <li>It's crucial to identify and treat patients at very high cardiovascular risk, including those with diabetes, severe chronic kidney disease, or subclinical atherosclerosis.</li>
 <li>General practitioners (GPs) play a vital role in recognizing and managing high-risk patients.</li>
 <li>Barriers to accessing new therapies for cardiovascular risk reduction need to be addressed.</li>
 <li>The benefits of LDL reduction are significant, especially for high-risk patients, leading to fewer cardiovascular events and improved quality of life.</li>
</ul>

Watch the interview here or read the summary below:

Understanding Cardiovascular Risk and Prevention: Insights from Professor Pasquale Perrone-Filardi

In a recent interview, Professor Pasquale Perrone-Filardi, a full Professor of Cardiology at the Federico Secondo University of Naples and the current president of the Italian Society of Cardiology, shared his expert insights on the critical role of LDL-Cholesterol (LDL-C) in cardiovascular health. He emphasized that LDL-C is the most significant risk factor for atherosclerotic disease, which is a leading cause of mortality and morbidity globally, particularly in developed countries.

Professor Filardi highlighted the importance of reducing LDL-C across all cardiovascular risk categories to implement effective prevention strategies. He pointed out that the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) guidelines provide clear targets and high-level recommendations for different cardiovascular risk categories. These guidelines are crucial for refining the identification of patients at very high cardiovascular risk, which includes not only those with previous cardiovascular events but also new categories of patients who are at similar risk levels.

The professor stressed the need to recognize and treat these high-risk patients, such as those with diabetes and cardiovascular risk factors, severe chronic kidney disease, or subclinical atherosclerosis, in the same way as patients with previous cardiovascular events. He noted that barriers to accessing new therapies for reducing cardiovascular risk exist in many countries, and it is essential to spread the new paradigm within the clinical community, especially among general practitioners (GPs).

Professor Filardi also discussed the significant benefits of LDL reduction, particularly for high-risk patients. He explained that the higher the cardiovascular risk, the greater the absolute reduction in risk and the more substantial the benefits from LDL reduction. This approach not only helps prevent major cardiovascular events and avoidable deaths but also reduces comorbidities and improves the quality of life for patients who might otherwise suffer from severe disabilities due to strokes or myocardial infarctions.

In conclusion, Professor Filardi's insights underscore the importance of comprehensive cardiovascular risk management and the need for widespread implementation of ESC/EAS guidelines to improve patient outcomes and reduce the burden of cardiovascular diseases.

The phase III ODYSSEY CHOICE I study evaluated the efficacy, long-term safety, and tolerability of alirocumab 300 mg every 4 weeks, with possible adjustment to 150 mg every 2 weeks at Week 12, in patients at moderate to very-high cardiovascular disease (CVD) risk, both on and off statins. Patients with LDL-C levels ≥1.8 mmol/L or ≥2.6 mmol/L, depending on their CVD risk, were included. The study randomized patients in a 4:2:1 ratio to receive alirocumab 300 mg every 4 weeks, placebo, or alirocumab 75 mg every 2 weeks for 48 weeks.
Efficacy results showed significant LDL-C reductions from baseline to Weeks 21-24 with alirocumab 300 mg every 4 weeks compared to placebo, with mean reductions of 56.9% in non-statin patients and 65.8% in statin-treated patients. These reductions were maintained through Week 48. Patients not achieving target LDL-C levels at Week 8 had their doses adjusted to 150 mg every 2 weeks (14.7% and 19.3% of patients respectively in the no statin and concomitant statin populations), reducing LDL-C variability.
Safety results indicated similar rates of treatment-emergent adverse events between alirocumab and placebo groups, apart from higher injection-site reactions in the alirocumab 300 mg every 4 weeks group, mostly mild.

Roth Eli M et al. Atherosclerosis vol. 254 (2016): 254-262

A phase III randomized trial evaluating alirocumab 300 mg every 4 weeks as monotherapy or add-on to statin: ODYSSEY CHOICE I

<h2>Conclusion</h2>
Alirocumab 300 mg every 4 weeks, with potential dose adjustment, is an effective and well-tolerated option for LDL-C lowering in patients at high CVD risk, in addition to maximally tolerated statins and ezetimibe.

READ THE PUBLICATION

<h2>Introduction to the current care</h2>
<ul>
 <li>Significant gaps exist between clinical guidelines and actual clinical practice for lipid management across Europe. 
 &nbsp; 
 <ul>
 <li>54% achieved the risk-based goal set in 2016.1</li>
 <li>Only 33% met the more stringent 2019 risk-based goal.1 
 &nbsp;</li>
 </ul></li>
 <li>75% of the patients were prescribed a HI statin at discharge after an event BUT 31% of the patients did not reach their LDL target of 1.4mmol/L during followup.2</li>
</ul>

<h2>ACS Patients</h2>
<ul>
 <li>10% risk of new MI/CVA/CV death within 100 days post-ACS.3 
 &nbsp;</li>
 <li>Briefly reducing very early on LDL-C after ACS even when you stop additional therapy led to better outcomes sustained over 4 years.</li>
</ul>

Good incentive to strike early, strike strong, even when they’re not adherent.

<ul>
 <li>LDL-C lowering is accompanied by other things such as inflammatory marker decrease, plaque stabilisation with a thicker fibrous cap and less arterial inflammation.3</li>
</ul>
<h3>Take home messages</h3>
<ul>
 <li>No need to start with a conservative, lenient LLT in the post-ACS setting. 
 &nbsp;</li>
 <li>Start with combination therapy in the acute setting. 
 &nbsp;</li>
 <li>Guidelines advise a stepwise approach - but who will do it?</li>
</ul>

Challenge: Determining responsibility for implementation and managing the time required.

<h2>Very high risk patients</h2>
The more vascular beds, coronary, peripheral and neurological are affected, the higher the risk.

People with prediabetes and diabetes have a higher risk compared to non diabetes.
Higher baseline CV risk correlated with greater absolute risk reduction from LLT.5
<h3>Take home messages</h3>
<ul>
 <li>Adopt early and aggressive LLT as the standard for both ACS and high-risk non-ACS patients. 
 &nbsp;</li>
 <li>Shift from conservative to aggressive approaches, ensuring optimal guideline-directed medical therapy from the start.</li>
</ul>

Prof. Dr. Halvorsen, Prof. Dr. Sinnaeve & Prof. Dr. Martens

Why Don’t We Strike Early, Strike Strong?

LINK TO ESC GUIDELINES

LINK TO CONSENSUS PAPER

Prof. Dr. Halvorsen, Prof. Dr. Sinnaeve &amp; Prof. Dr. Martens

<h2>Informatie en support voor u en uw CVRM patiënt</h2>

Bekijk deze korte animatie en ontdek alle ondersteunende materialen welke Sanofi u kosteloos aanbiedt!

<h2>Odyssey Outcomes acute coronary syndrome with or without diabetes</h2>

De&nbsp;ODYSSEY OUTCOMES&nbsp;sub analyse data over diabetes zijn al weer even beschikbaar. Wist u dat het risico op een ernstig ongewenst cardiovasculair voorval (MACE) ongeveer 2x zo groot is bij&nbsp;DIABETES PATIËNTEN&nbsp;ten opzichte van patiënten zonder diabetes, ondanks een baseline LDL van 2,2 mmol/L en gebruik van hoge intensiteit statine1? NEE? Bekijk deze korte animatie.

<h2>Odyssey Outcomes mortality video</h2>

De&nbsp;ODYSSEY OUTCOMES&nbsp;studie data over&nbsp;MORTALITEIT&nbsp;zijn al weer even beschikbaar. Wellicht bent u nog niet in de gelegenheid geweest om het hele artikel te lezen, bekijk dan hier deze animatie.

Praluent: video's en animaties

<h2>CVRM en de samenwerking tussen de 1e en 2e lijn</h2>

<h2>Cardiovasculair risicomanagement en therapietrouw</h2>

<h2>Het belang van een laag cholesterol in de eerste lijn</h2>

<h2>CVRM en Diabetes in 2e lijn: belangrijk!</h2>

<h2>CVRM en diabetes in de 1e lijn: de NHG adviseert!</h2>

 Praluent: podcasts

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