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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #9 2025

The analysis estimated that moving from statin monotherapy
to an early combination strategy could prevent one MACE for Dyslipidaemia
every 53 patients treated over three years (number needed
to treat [NNT] = 53). Moving from a delayed to an early
combination strategy would result in an NNT of 143 to prevent
one MACE. This translates to a significant potential health
gain, with the authors estimating that if all patients received
early combination LLT, an additional 477 MACE events could
have been prevented in the study population. Sensitivity
analyses using skeletal fractures as a negative control outcome
suggested that the observed differences were unlikely due to CLICK HERE
unmeasured confounding related to frailty. TO LISTEN TO DR. VALENTIN FUSTER
DISCUSS THIS STUDY (10:45).
This study highlights that delaying the use of combination
LLT or relying solely on high-intensity statin monotherapy
after an MI is associated with avoidable adverse outcomes.
The findings provide strong support for early combination CLICK HERE
therapy with statins and ezetimibe after an MI. This proactive FOR THE LINK TO FULL ARTICLE
approach facilitates faster achievement of LDL-C goals and
leads to tangible reductions in MACE and cardiovascular death,
offering significant public health benefits. While acknowledging
limitations such as the short follow-up for in-hospital initiation
and potential residual confounding inherent to observational
studies, the authors stress that the need for combination therapy
is inevitable for most patients after an MI.

Target populations for novel triglyceride-lowering therapies.
Nordestgaard AT, et al. J Am Coll Cardiol. 2025;85(19):1876-1897.

Novel triglyceride-lowering therapies designed to address conditions such as acute pancreatitis, ASCVD, and MASH have been
found to have a much more pronounced effect than previously used therapies. Drawing on epidemiologic and genetic evidence,
a causal link between elevated triglyceride-rich lipoproteins (TRLs) and incident ASCVD can be established. Since the primary
cause of TRL-mediated atherosclerosis seems to be the intimal accumulation of remnant cholesterol rather than triglycerides, prior
triglyceride-lowering therapies, such as fibrates, omega-3 fatty acids, and niacin, have failed to convincingly reduce cardiovascular
risk in contemporary statin-treated patients. This underscores an unmet need for more effective triglyceride and remnant
cholesterol-lowering agents, particularly for severe hypertriglyceridaemia not solely attributable to familial chylomicronemia
syndrome (FCS). This review provides a comprehensive overview of the target populations, the novel drugs under development,
and the supporting evidence.

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