From the Guidelines
LDL-P levels should be managed aggressively to reduce cardiovascular risk, with a goal of lowering LDL-C to <1.4 mmol/L (<55 mg/dL) and reducing it by at least 50% if the baseline LDL-C level is 1.8-3.5 mmol/L (70-135 mg/dL), as recommended by the 2021 ESC guidelines 1. To achieve this, lifestyle modifications such as a Mediterranean or DASH diet, regular exercise, weight management, and increasing soluble fiber intake should be implemented. Medications that can lower LDL-P include statins, ezetimibe, PCSK9 inhibitors, and bempedoic acid. It is essential to note that LDL-P provides valuable information because it accounts for particle size variations, with smaller, denser LDL particles being more dangerous as they can more easily penetrate arterial walls and promote atherosclerosis. Key considerations for managing LDL-P include:
- Focusing on lifestyle modifications to reduce cardiovascular risk
- Using medications such as statins and ezetimibe to lower LDL-C levels
- Considering the addition of PCSK9 inhibitors or bempedoic acid for further reduction of LDL-P
- Monitoring LDL-P levels to assess the effectiveness of treatment and adjust as needed. The importance of therapeutic lifestyle changes (TLC) in clinical management for persons at risk for cardiovascular disease (CVD) should not be diminished, as emphasized by the ATP III report 2.
From the FDA Drug Label
In the overall population, the mean LDL-C reduction from baseline was 22%. About one-third of the patients benefited from increasing their dose from 20 mg to 40 mg with further LDL-C lowering of greater than 6%. In the 27 patients with at least a 15% reduction in LDL-C, the mean LDL-C reduction was 30% (median 28% reduction) Among 13 patients with an LDL-C reduction of <15%, 3 had no change or an increase in LDL-C. Reductions in LDL-C of 15% or greater were observed in 3 of 5 patients with known receptor negative status. Table 15: ... LDL-C112.5-54.4 (-59.1, -47.3) -57.3 (-59.4, -52.1) Table 16: ... LDL-C5 (-30, 52)-28 (-71, 2)-45 (-59, 7)-31 (-66, 34)-43 (-61, -3)
The LDL-C reduction with rosuvastatin is 22% on average, with some patients experiencing a reduction of greater than 6% when increasing their dose from 20 mg to 40 mg 3.
- The mean LDL-C reduction was 30% in patients with at least a 15% reduction in LDL-C.
- Reductions in LDL-C of 15% or greater were observed in 3 of 5 patients with known receptor negative status.
- In adult patients with primary dysbetalipoproteinemia, rosuvastatin 10 mg and 20 mg reduced LDL-C by 54.4% and 57.3%, respectively 3.
- In adult patients with primary hypertriglyceridemia, rosuvastatin 5 mg to 40 mg reduced LDL-C by 28% to 43% 3.
From the Research
LDL P
- LDL P, or low-density lipoprotein particle number, is a measure of the number of LDL particles in the blood, which is a risk factor for cardiovascular disease 4.
- Studies have shown that LDL P is a superior predictor of coronary heart disease risk compared to LDL cholesterol (LDL-C) levels 4.
- The use of LDL P as a target of therapy has been recommended, in addition to LDL-C and non-high-density lipoprotein cholesterol, to better manage cardiovascular risk 4.
- Statins, such as rosuvastatin, can lower LDL-C levels, but may not always reduce LDL P to the same extent 5.
- Combination therapy with ezetimibe, a cholesterol absorption inhibitor, can further reduce LDL-C and LDL P levels, and has been shown to be effective in reducing cardiovascular risk 6, 5.
- PCSK9 inhibitors, such as evolocumab and alirocumab, can also significantly reduce LDL-C and LDL P levels, and have been shown to reduce cardiovascular events and all-cause mortality in high-risk patients 7.