Future Direction of Lipid-Modifying Therapy

The results of several clinical trials have clearly shown that the use of statins and the subsequent reduction of LDL-C levels are associated with a decrease in atherosclerotic cardiovascular disease (ASCVD) complications by approximately 30%. Thus, 70 % of patients continue to have residual risk. Reduction of this residual risk is the greatest challenge in preventive cardiology today. In this session, we will consider the future direction of the use of lipid-modifying agents for the treatment of ASCVD. The 2013 ACC/AHA Blood Cholesterol Guidelines, based mainly on clinical trial evidence, were focused on statin therapy and LDL-C reduction without lipid target values. The guidelines raised some controversy regarding the direction of dyslipidemia treatment. Very recently, the National Lipid Association (NLA) guidelines supported the use of non-HDL-C measurements and gave target values for lipid parameters. Lipoprotein levels are not static, but rather dynamic. They are controlled by various factors (through enzymes, proteins, membrane lipid transporters, PCSK9, etc.), and are maintained in dynamic equilibrium in the circulation. A better understanding of these issues may lead to the development of strategies to lower residual risk. These include identification of patients whose residual risk after statin/LDL-based therapy may be lowered by existing and new HDL-raising drugs, apo A-I mimetic peptides, modulators of triglycerides, lipid transporters, or inhibitors of cholesterol absorption. This symposium will explore opportunities for the discovery of new drugs through genomics or our current understanding of molecular mechanisms, and will comprehensively address recent advances in the management of dyslipidemia, both alone and co-existing with diabetes mellitus, metabolic syndrome, chronic renal disease and other high risk patient populations.