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(ASCVD) risk. Since the publication of that document, 5. Fruchart JC, Sacks F, Hermans MP, et al. The Residual Risk Reduction
additional evidence and perspectives have emerged Initiative: a call to action to reduce residual vascular risk in patients
from randomized clinical trials and other sources, with dyslipidemia. Am J Cardiol. 2008;102(10 Suppl):1K-34K.
particularly considering the longer-term efficacy and 6. Lee M et al.Atherosclerosis 2011;217; 492– 8
safety of proprotein convertase subtilisin / kexin 9 7. N Engl J Med. 2010:363(7):692-4 Diabetes Care 32:493–498, 2009
(PCSK9) inhibitors in secondary prevention of ASC- 8. Børge G Nordestgaard, Anette Varbo Lancet 2014; 384: 626–635
VD. Most notably, the FOURIER (Further Cardiovas-
cular Outcomes Research with PCSK9 Inhibition in 9. Terry A. Jacobson et al , National Lipid Association recommendations
for patient-centered management of dyslipidemia: Part 1 – executive
Subjects with Elevated Risk) trial and SPIRE-1 and -2 summary* Journal of Clinical Lipidology 2014 ;8 473 – 488 .
(Studies of PCSK9 Inhibition and the Reduction of
Vascular Events), assessing evolocumab and boco- 10. An International Atherosclerosis Society Position Paper 2013,Global Rec-
ommendations for the Management of Dyslipidemia [ Full report ]
cizumab, respectively, have published final results of
cardiovascular outcomes trials in patients with clinical 11. Kausik K.Ray et al , European Heart Journal doi : 10.1093 /eurheartj
/ ehu 107 .
ASCVD and in a smaller number of high-risk primary
prevention patients. In addition, further evidence on 12. 12. SS Iyengar,Raman Puri ,S.N.Narasingan ,Lipid Association of India
the types of patients most likely to benefit from the Expert Consensus Statement on Management of Dyslipidemia in Indi-
ans 2016 : Part 1 Journal of Association of Physicians of India [JAPI]
use of ezetimibe in addition to statin therapy after Supplement copy March 2016 ,Vol : 64 Issue No.3
acute coronary syndrome has been published. Based
on results from these important analyses, the ECDP
writing committee judged that it would be desirable
to provide a focused update to help guide clinicians
more clearly on decision making regarding the use
of ezetimibe and PCSK9 inhibitors in patients with
clinical ASCVD with or without comorbidities.
Conclusion

There is a need for absolute risk assessment in ev-
eryone and this is the best approach in managing
Lipids . We need to assess the risk and then go with
which ever is greater i.e. a 50% LDL-C reduction or a
target . In those at highest absolute risk we have to
maximise the dose of the statin. We need to decide
whether this is enough for this person’s level of risk
or should we go lower ? Lower could be a greater
percentage reduction in LDL-C or a target .LAI Con-
sensus statement in the management of Lipids for
Indians has solved many issues pertaining to bring-
ing down LDL –c goal to 50 mg in very high risk group
. Almost all academic bodies are now recommending
55 mgs of LDL goal for very high risk group . Infact ,
LAI gets the credit in recommending such low levels
before any other academic bodies attempted to do .
Refer : www.lipid.net.in

References:
1. Grundy SM et al. Circulation. 2004;110:227–239. Smith SC Jr et al.
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2. Prakash Deedwania & Rajiv Gupta et al 2014 Diabetes & Metabolic
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3. Endocrine Practice 2013;19 (Suppl 2):1-48.
4. JAMA 2005; 294: 326-333 , Circulation 2005; 112: 3375-3383 & Na-
tional Lipid Association recommendation . Kastelein JJ, Van der steeg
WA, Holme L, et al: Circulation 2008;117: 3002-3009 .

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