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Open access Aug 2026

Contemporary non-statin therapies for dyslipidemia management: achieving current lipid targets

This expert position paper proposes practical algorithms for a precision medicine approach in Latin America, matching treatment intensity to individual risk profiles for the primary and secondary prevention of atherosclerotic cardiovascular disease.

C. Ponte-Negretti, A. Lorenzatti, F. Wyss-Quintana et al. · 0 citations
Review Open access Aug 2026

Targeting Dyslipidemia in Ischemic Stroke: Pathophysiology, Clinical Evidence, and Future Perspectives.

Dyslipidemia is a major risk factor for atherosclerosis, and high low-density lipoprotein (LDL) cholesterol is closely associated with the onset of atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease. Numerous large-scale clinical trials have demonstrated that LDL cholesterol-lowering therapy, primarily involving statins, reduces not only coronary events, but also stroke, and has been established as a cornerstone of cardiovascular prevention. However, ischemic stroke is a group of diseases comprising different pathologies, such as atherothrombotic stroke, cardioembolic stroke, and small-vessel disease; the involvement of dyslipidemia and the efficacy of lipid-lowering therapy vary significantly depending on the subtype. Therefore, the evidence established for coronary artery disease cannot necessarily be applied directly to stroke management, and establishing lipid management strategies tailored to each subtype has become a critical challenge in stroke management. Furthermore, in recent years, in addition to LDL cholesterol-lowering therapy, treatments targeting hypertriglyceridemia, lipoprotein(a) [Lp(a)], and residual inflammatory risk have advanced, and the development of new therapeutic agents-such as PCSK9 inhibitors, selective PPARα modulators, and ATP citrate lyase inhibitors-is progressing, thus raising expectations for their application in stroke prevention. This article provides an overview of domestic and international guidelines for dyslipidemia and summarizes the association between dyslipidemia and ischemic stroke from the perspectives of pathophysiology, pathological findings, and imaging and blood biomarker. In addition, it outlines the latest evidence from large-scale clinical trials, new lipid-lowering therapies, acute-phase lipid management, and interventions targeting residual risk, and discusses the current status and future prospects of lipid management tailored to specific stroke subtypes.

Junya Aoki · 0 citations
Review Open access Jul 2026

NOVEL DIRECTIONS IN LIPID-LOWERING THERAPY FOR THE PREVENTION OF CARDIOVASCULAR DISEASES

Cardiovascular diseases remain the leading cause of mortality worldwide despite significant advances in preventive cardiology. Dyslipidemia is one of the most important modifiable risk factors contributing to the development and progression of atherosclerotic cardiovascular disease. While statins continue to represent the cornerstone of lipid-lowering therapy, a substantial proportion of high-risk patients fail to achieve recommended low-density lipoprotein cholesterol targets or experience recurrent cardiovascular events despite optimal treatment. Recent years have witnessed remarkable progress in the development of novel lipid-lowering agents that target different pathways of lipoprotein metabolism, offering improved efficacy and longterm cardiovascular protection. Emerging therapeutic strategies include proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies, small interfering RNA (siRNA)-based therapies such as inclisiran, adenosine triphosphate citrate lyase inhibitors represented by bempedoic acid, and innovative approaches targeting lipoprotein(a), angiopoietinlike protein 3, and apolipoprotein C-III. These therapies not only achieve profound reductions in LDL-C but also address residual cardiovascular risk that persists despite intensive statin therapy. Furthermore, advances in precision medicine, genetic profiling, and artificial intelligence have facilitated individualized lipid management strategies, improving patient adherence and optimizing clinical outcomes. This review summarizes current evidence regarding novel lipid-lowering therapies, their mechanisms of action, clinical efficacy, safety profiles, and future perspectives in the prevention of cardiovascular diseases.

Galymzhan Qorazov, Ulykbek Daurenov, Aisulu Amirbai et al. · 0 citations
Aug 2026

Intensified lipid-lowering strategies and their effect on atherogenic and metabolic markers in coronary artery disease: a prospective cohort study.

BACKGROUND AND AIMS To evaluate the effects of varying lipid-lowering therapy (LLT) strategies on lipid profiles and insulin resistance (IR) biomarkers in coronary artery disease (CAD) patients. METHODS AND RESULTS This prospective observational study enrolled 1391 CAD patients receiving monotherapy (statin or ezetimibe), dual therapy (statin + ezetimibe), or triple therapy (dual + PCSK9 inhibitor) at discharge. After a median 1-year follow-up, attainment rates and changes in low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), non-high-density lipoprotein cholesterol (non-HDL-C), remnant cholesterol (RC), total cholesterol (TC), triglyceride-glucose (TyG) index, and atherogenic index of plasma (AIP) were assessed. Linear regression evaluated associations between LLT intensity and biomarker percent change, with subgroup and interaction analyses exploring effect modification by baseline characteristics. Triple therapy achieved the largest reductions in LDL-C (-62.9%), non-HDL-C (-57.5%), ApoB (-56.1%), RC (-45.1%), and TyG (-7.1%), followed by dual therapy. Higher LLT intensity was independently associated with greater reductions in LDL-C, non-HDL-C, and TC, with triple therapy outperforming dual therapy. Greater TyG reduction with triple therapy was significant in unadjusted but not adjusted analyses. In the triple therapy group, goal attainment of LDL-C, non-HDL-C, ApoB, and RC improved significantly from baseline (all P < 0.01). BMI significantly modified lipid-lowering effects, with greater LDL-C, non-HDL-C, and TC reductions in non-overweight/obese than in overweight/obese patients. CONCLUSION Triple LLT was associated with more comprehensive control of atherogenic lipid markers, with a similar trend for IR markers. Notably, stratified intensification of LLT may support individualized risk-factor management in CAD, although cardiovascular outcome benefits require further validation.

Lei Bao, Zhi-Fan Li, Xiao-Ning Liu et al. · 0 citations
Open access Aug 2026

Lipid Profiles and Lipid-Lowering Therapy at the Time of Acute Myocardial Infarction

Background Low-density lipoprotein cholesterol (LDL-C) lowering with lipid-lowering therapy (LLT) is foundational for atherosclerotic cardiovascular disease (ASCVD) prevention. Objectives The purpose of this study was to evaluate LDL-C levels and LLT at the time of acute myocardial infarction (AMI). Methods We retrospectively assessed LDL-C levels and LLT use at presentation and discharge among patients hospitalized with AMI from March 2018 to August 2022. Results Among AMI patients with no prior ASCVD diagnosis (n = 1,159), 94.7% had LDL-C ≥55 mg/dL, 86.7% had LDL-C ≥70 mg/dL, and 33.6% were on outpatient statin therapy prior to admission. Among those not taking LLT and aged 18 to 79 years with available risk data, 89.0% met statin eligibility in the 2026 U.S. dyslpidemia guideline. Among AMI patients with prior ASCVD (n = 689), 81.0% had LDL-C ≥55 mg/dL, 64.7% had LDL-C ≥70 mg/dL, 73.7% were previously on statins, and 3.9% were on combination LLT. Although 94.0% of all AMI patients were discharged on statins (81.8% with high intensity), only 5.0% were discharged with combination LLT. Among patients with prior ASCVD and LDL-C ≥55 mg/dL, 24.9% had an increase in statin intensity, 7.2% received combination LLT, and 47.0% received no LLT intensification at discharge. Conclusions In a contemporary AMI cohort, ∼2 in 3 patients presenting with a new ASCVD diagnosis were not previously on a statin, and nearly all had LDL-C ≥55 mg/dL. Among AMI patients with known ASCVD, ∼1 in 4 were not on a statin, and ∼4 in 5 had LDL ≥55 mg/dL. Combination LLT remained low at presentation and discharge despite suboptimal LDL-C, underscoring actionable gaps in ASCVD management.

Mohammed Essa, Qifan Wu, Yuan Lu et al. · 0 citations