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LDL cholesterol: controversies and future therapeutic directions
Abstract
Lifelong exposure to raised concentrations of LDL cholesterol increases cardiovascular event rates, and the use of statin therapy as an adjunct to diet, exercise, and smoking cessation has proven highly effective in reducing the population burden associated with hyperlipidaemia. Yet, despite consistent biological, genetic, and epidemiological data, and evidence from randomised trials, there is controversy among national guidelines and clinical practice with regard to LDL cholesterol, its measurement, the usefulness of population-based screening, the net benefit-to-risk ratio for different LDL-lowering drugs, the benefit of treatment targets, and whether aggressive lowering of LDL is safe. Several novel therapies have been introduced for the treatment of people with genetic defects that result in loss of function within the LDL receptor, a major determinant of inherited hyperlipidaemias. Moreover, the usefulness of monoclonal antibodies that extend the LDL-receptor lifecycle (and thus result in substantial lowering of LDL cholesterol below the levels achieved with statins alone) is being assessed in phase 3 trials that will enrol more than 60,000 at-risk patients worldwide. These trials represent an exceptionally rapid translation of genetic observations into clinical practice and will address core questions of how low LDL cholesterol can be safely reduced, whether the mechanism of LDL-cholesterol lowering matters, and whether ever more aggressive lipid-lowering provides a safe, long-term mechanism to prevent atherothrombotic complications.
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“However, their hepatotoxicity, high cost, inconvenience, and a general lack of availability outside the tertiary referral centers imply that their use is limited [10].”
From Effects of aerobic exercise on lipids and lipoproteins (2017) · cites this paper as [10]
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Metadata
- Authors
- Ridker, P. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Ridker, Paul M
- ORCID
- Ridker, Paul M
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2014-08
- Volume
- 384
- Issue
- 9943
- Pages
- 607-617
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2058652637
- Cited by
- 274
- References
- 104
- Citations by year
- 2026: 7 · 2025: 23 · 2024: 13 · 2023: 20 · 2022: 13 · 2021: 14 · 2020: 25 · 2019: 22 · 2018: 31 · 2017: 29 · 2016: 35 · 2015: 38 · 2014: 4
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Lipoproteins and Cardiovascular Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- LDL cholesterol, hyperlipidemia, statin therapy, LDL receptor, PCSK9 inhibitors, monoclonal antibodies, LDL cholesterol measurement, mass screening, treatment goals, cardiovascular risk, atherothrombotic complications
- MeSH terms
- Animals, Hypolipidemic Agents, Humans, Hypercholesterolemia, Cholesterol, LDL, Risk Factors, Risk Assessment, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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