Call to lower Australian LDL cholesterol targets following new EU guidelines

The Australian LDL cholesterol (LDL-C) targets in secondary prevention patients are being called into question following the recent publication of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on dyslipidaemias.

For very-high risk patients in secondary prevention, the guidelines recommend a new LDL-C goal of <1.4 mmol/L and an LDL-C reduction of at least 50 per cent from baseline. For those with recurrent events within two years while taking maximally tolerated statin therapy, a goal of <1.0 mmol/L for LDL-C may be considered.

According to a recent article published in MJA Insight by clinical cardiologist and Professor of Medicine at Flinders University, Philip Aylward, the Australian LDL-C targets for patients at high risk of cardiovascular events, should be revised to <1.4mmol/L to match the European guidelines.

“In Australia, various guidelines suggest a target of <1.8mmol/L for LDL-C for secondary prevention patients. However, the new target for patients post an ACS (acute coronary syndrome) or otherwise at very high risk should be <1.4mmol/L. Lowering LDL-C reduces cardiovascular events, including death, myocardial infarction (MI) and stroke.

To achieve an LDL-C target of <1.4mmol/L many patients will require not only high intensity statin and ezetimibe but additional therapies. Currently an effective additional therapy is a PCSK9 inhibitor,” said Professor Aylward.

PCSK9i therapy now clinically recommended as secondary prevention for patients at very-high risk not achieving their LDL-C goal on a maximum tolerated dose of statin and ezetimibe.

The new guidelines are supported by data from the landmark ODYSSEY OUTCOMES trial assessing the effect of Sanofi’s Praluent (alirocumab) versus placebo in patients who experienced ACS, median of 2.6 months before randomisation. Praluent significantly reduced ischemic events, including all-cause mortality and MI.

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