There has been a lot of debate on ASCVD on this forum. I found this recent presentation useful in my understanding of where the research stands on lowering risk and events. The finding that lower LDL is better is illuminated with important context about other factors that are also important (why some people don’t get the full benefit). Also, the idea that HDL doesn’t matter now seems wrong to me (the research findings continues to progress). Lastly, the size of plaques AND rate of increase in size are both important contributors to risk.
This is the 2023 Anitschkow lecture given by Professor Stephen Nicholls at the 91st EAS Congress.
Professor Nicholls is Director of Monash Heart and Professor of Cardiology and Inaugural Director of the Victorian Heart Institute at Monash University, Australia. He is President-elect of the Cardiac Society of Australia and New Zealand, President of the Australian Atherosclerosis Society and Founding Chair of the Asia Pacific Cardiometabolic Consortium.
Professor Nicholls presented data on the HDL functionality and antiatherogenic role, as well as the effects of HDL on atheromatous plaque volume, in vivo. Subsequently, he discussed the effect of statins or their combination with antiPCSK9 mabs on plaque volume and composition. He also discussed results from clinical trials of the CETP inhibitors, Omega-3 fatty acids and bempedoic acid and presented ongoing clinical studies on Lp(a) and antidiabetic drugs. At the end of his lecture, he discussed the possible usefulness of polygenic risk scores for more efficient and intensive patient treatment. It is a very important and comprehensive lecture you should not miss.