[Targeting dyslipidaemia in primary prevention of cardiovascular disease].

Prevention of cardiovascular disease remains a key-objective from a health care point of view. The present article focuses on primary prevention, i.e.

[First-line treatment of hypercholesterolemia : start with statin monotherapy or ezetimibe-statin combination ?].

Hypercholesterolemia, especially LDL-C («Low-Density-Lipoprotein - Cholesterol»), is a major cardiovascular risk factor, especially for coronary artery disease. Patients at high or very high cardiovascular risk should reach LDL concentrations as low as possible («the lower, the better»), with a reduction of at least 50 % from baseline levels according to the most recent guidelines, especially those in secondary prevention. An ezetimibe-statin combination most often allows to reach this goal thanks to a complementary action.

[Evolocumab (Repatha®) : new therapy ofhypercholesterolaemia for secondary prevention of atherosclerotic disease].

Evolocumab is a monoclonal antibody that blocks PCSK9 («Proproteine Convertase Subtilisine/Kexine type 9»). It exerts a rapid, potent and sustained reduction of LDL cholesterol (LDL-c) levels in combination with statin therapy. It was first reimbursed for the treatment of familial hypercholesterolaemia.

[Bempedoic acid and inclisiran : two new drugs to treat hypercholesterolemia].

Last European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines on dyslipidemia published in 2019 recommend an LDL-cholesterol goal < 1.4 mmol/l (< 55 mg/dl) for people at very high cardiovascular risk. They propose combinations of lipid lowering therapies in addition to statins if necessary to meet this objective, which is very rarely reached in this at risk population.

Evolving concepts on the management of dyslipidaemia.

It has been well established that low-density lipoproteins (LDL) and other apolipoprotein B-containing lipoproteins are causally related to atherosclerotic cardiovascular disease (ASCVD) and that lowering these lipoproteins reduces the risk of ASCVD. By lowering LDL particles as much as possible, ASCVD can be prevented. There seems to be no LDL-cholesterol (LDL-C) threshold below which no further ASCVD prevention can be achieved.

[Statins and new-onset diabetes : benefit-risk balance].

Statins are the most commonly prescribed cholesterol-lowering drugs for cardiovascular prevention. Data from randomized clinical trials have shown an increased risk of diabetes mellitus type 2 (DT2) on statin treatment. These findings have been confirmed in genetic Mendelian randomization studies and in observational cohorts.

A Belgian consensus strategy to identify familial hypercholesterolaemia in the coronary care unit and its subsequent cascade screening and treatment: BEL-FaHST (The BELgium Familial Hypercholesterolaemia STrategy).

Background And Aims: Familial hypercholesterolaemia (FH) is an autosomal dominant lipoprotein disorder characterized by significant elevation of low-density lipoprotein cholesterol (LDL-C) and markedly increased risk of premature cardiovascular disease (CVD). Because of the very high coronary artery disease risk associated with this condition, the prevalence of FH among patients admitted for CVD outmatches many times the prevalence in the general population. Awareness of this disease is crucial for recognizing FH in the aftermath of a hospitalization of a patient with CVD, and also represents a unique opportunity to identify relatives of the index patient, who are unaware they have FH.

[Cardiovascular protection of patients with type 2 diabetes : from EMPA-REG OUTCOME to LEADER].

Two clinical trials demonstrate the superiority versus a placebo of two antidiabetic drugs in patients with type 2 diabetes and high cardiovascular risk. Empagliflozin, an inhibitor of sodium-glucose type 2 (SGLT2) cotransporters, in EMPA-REG OUTCOME, and liraglutide, an agonist of glucagon-like peptide-1 (GLP-1) receptors, in LEADER, showed a significant reduction in major cardiovascular events (- 14 and - 13 %, respectively), cardiovascular mortality (- 38 and - 22 %, respectively) and all-cause mortality (- 32 and - 15 %, respectively). A lower progression of kidney disease and less renal events were also reported.

[Therapeutic impact of screening for myocardial ischemia among asymptomatic type 2 diabetic subjects].

Coronary artery disease is the major cause of mortality of type 2 diabetic subjects. Its early diagnosis to prevent progression and clinical events has intuitive appeal. Somehow, rationale for screening has not been clearly established.

Familial colloid cyst of the third ventricle: neuroendocrinological follow-up and review of the literature.

Colloid cysts of the third ventricle are rare, benign cysts of endodermal origin. Between 1989 and 1999, eight patients with this lesion (five females, three males), with a mean age of 40.5 years (range 20-54), were identified out of 1354 operated for tumours of the central nervous system.