Advances and Controversies in Lipid Lowering

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Seminar by Professor Jane Armitage FRCP FFPH , Professor of Clinical Trials and Epidemiology, Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford

Wednesday 25th January at 1pm, Seminar Rooms, Strangeways Research Laboratory.

Abstract:

Low-density lipoprotein [LDL] cholesterol has been recognised as a causal risk factor for coronary heart disease for many decades based on data from observational studies and randomised intervention trials. The observational associations between LDL cholesterol and risk are less clear for cerebrovascular disease, but the intervention trials clearly show reductions in risk of ischaemic stroke with LDL lowering interventions. As a result of a large body of high-quality randomised trial data showing both efficacy and safety, statins have become the first-line drug for LDL -lowering. They are now largely off-patent and widely used for both secondary and primary prevention of cardiovascular disease. New potent LDL -lowering treatments use monoclonal antibodies to block the activity of PCSK9 and have recently been licensed for use in limited circumstances. Results from the first of the large outcome trials of these treatments are imminent. The drive to find a market for these and other lipid-modifying drugs in development may be behind the recent increase in interest and publications on ‘statin intolerance’. Claims have been made that intolerance to statin therapy is a common problem, but the data from large blinded randomised trials do not support this. Widespread media coverage of this controversy has resulted in people who might gain substantial benefit choosing to discontinue statin treatment. Other new lipid modifying agents are in development including oral CETP -inhibitors, and oligonucleotides and small interfering RNAs which can block specific lipid pathways.