EditorialIntensive LDL Reduction Post Acute Coronary Syndromes: A Catalyst for Improved Outcomes☆
Section snippets
Diabetes
Diabetes remains a major cause of CV disease with up to 25% of patients with ACS having this condition. Reduction in LDL-C remains the primary lipid target in the diabetic population, and there is evidence that more aggressive LDL-C lowering is more effective in reducing future CV events than moderate LDL-C lowering [6]. In the IMPROVE-IT subgroup of diabetic subjects, the decrease in CV events was even more pronounced than that observed in non-diabetic patients.
Residual dyslipidaemia (elevated
Familial Hypercholesterolaemia (FH)
Familial hypercholesterolaemia is the most common dominantly inherited disorder in humans and is most frequently caused by loss of function mutations in genes affecting the LDL receptor [9]. Therefore LDL-C levels in FH patients are markedly elevated from birth and accelerated atherosclerotic CV disease occurs early [9]. The prevalence of FH in Australia ranges from 1:200 to 1:350 individuals [9].
Familial hypercholesterolaemia warrants intensive lifelong LDL-C reduction from a young age.
Elderly
Cardiovascular disease (CVD) mortality and morbidity increase with increasing age, largely as a result of increased lifetime exposure as well as increased prevalence of CVD risk factors. Hospitalisation for CVD increases by a factor of over 18 for those aged 85+ years versus those aged younger than 30 years. In spite of this, life expectancy continues to increase and currently in Australia is now 80 years in men and 84 years in women ‘[10]. The number of people for whom lipid management is
Aboriginal and Torres Strait Islander People
Cardiovascular disease is the leading cause of death in Indigenous people accounting for 25% of deaths in New South Wales, Queensland, Western Australia, South Australia and the Northern Territory. After age adjustment, the mortality rate is almost twice as high in Indigenous people when compared to non- Indigenous people, and the primary contributor to the significantly lower life expectancy [11], [12].
Indigenous people with CVD tend to be younger, are more likely to smoke, suffer from high
Patients with Chronic Kidney Disease(CKD)
Patients with CKD continue to experience significant CVD morbidity and mortality. Although there are many important risk factors playing a role in the pathogenesis of CVD in CKD patients, dyslipidaemia represents one of the modifiable risk factors. Previous trials with statins in end stage renal disease did not show a significant clinical benefit. However, the Study of Heart and Renal Protection (SHARP) trial showed a significant reduction in the risk of major atherosclerotic events (RR=0.83,
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