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Purpose of Review <p>This review examines the role of lipid-lowering therapy (LLT) in the context of primary prevention of atherosclerotic cardiovascular disease (ASCVD), focusing on therapies that reduce serum concentrations of apolipoprotein B (ApoB) containing lipoproteins, specifically low-density lipoprotein (LDL). We discuss the role of different lipoproteins in atherosclerosis, current risk assessment tools for ASCVD prediction, highlight the key clinical trials of LLT in primary prevention, and emphasize the importance of cholesterol-years of exposure and earlier-in-life reductions in LDL that translate into better CV outcomes.</p> Recent Findings <p>While multiple risk calculators and biomarkers are available to assess the risk of ASCVD in the population, we need better tools to predict long-term ASCVD risk at the individual level. While ApoB concentration is considered the optimal marker of total atherogenic burden, the impact of LLT is more often clinically assessed by measuring LDL-cholesterol and non-HDL-cholesterol. Pharmacological interventions to treat hyperlipidemia, particularly those that lower ApoB-containing lipoproteins, have significantly lowered ASCVD. Although multiple new non-statin treatment options are currently available to reduce ApoB lipoprotein levels, the rates of prescription of LLT remain suboptimal. This review highlights the knowledge and practice gaps in utilizing LLT in primary ASCVD risk prevention.</p> Summary <p>The key to reducing primary ASCVD events lies in the early and effective management of dyslipidemia through well-established medications like statins, as well as newer, well-tolerated, and highly effective medications like proprotein convertase subtilisin-kexin type 9 inhibitors. After achieving non-HDL target goals, treatment strategies should consider targeting residual inflammatory risk. Clinicians should consider comprehensive screening strategies, including screening for biomarkers like lipoprotein (a), and engage in collaborative shared decision-making with patients for optimal primary ASCVD risk management.</p>

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Impact of Lipid Lowering Therapies on the Primary Prevention of Atherosclerotic Cardiovascular Disease

  • 期刊论文

  • 发表日期：

    2025年4月7日

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  • Akruti P. Prabhakar,
  • Deepak Vedamurthy,
  • Dinesh K. Kalra

摘要

Purpose of Review

This review examines the role of lipid-lowering therapy (LLT) in the context of primary prevention of atherosclerotic cardiovascular disease (ASCVD), focusing on therapies that reduce serum concentrations of apolipoprotein B (ApoB) containing lipoproteins, specifically low-density lipoprotein (LDL). We discuss the role of different lipoproteins in atherosclerosis, current risk assessment tools for ASCVD prediction, highlight the key clinical trials of LLT in primary prevention, and emphasize the importance of cholesterol-years of exposure and earlier-in-life reductions in LDL that translate into better CV outcomes.

Recent Findings

While multiple risk calculators and biomarkers are available to assess the risk of ASCVD in the population, we need better tools to predict long-term ASCVD risk at the individual level. While ApoB concentration is considered the optimal marker of total atherogenic burden, the impact of LLT is more often clinically assessed by measuring LDL-cholesterol and non-HDL-cholesterol. Pharmacological interventions to treat hyperlipidemia, particularly those that lower ApoB-containing lipoproteins, have significantly lowered ASCVD. Although multiple new non-statin treatment options are currently available to reduce ApoB lipoprotein levels, the rates of prescription of LLT remain suboptimal. This review highlights the knowledge and practice gaps in utilizing LLT in primary ASCVD risk prevention.

Summary

The key to reducing primary ASCVD events lies in the early and effective management of dyslipidemia through well-established medications like statins, as well as newer, well-tolerated, and highly effective medications like proprotein convertase subtilisin-kexin type 9 inhibitors. After achieving non-HDL target goals, treatment strategies should consider targeting residual inflammatory risk. Clinicians should consider comprehensive screening strategies, including screening for biomarkers like lipoprotein (a), and engage in collaborative shared decision-making with patients for optimal primary ASCVD risk management.