ESC Congress 2017 In Review -- Main Edition - 27

ESC Congress 2017

on this issue have been inconsistent. One meta-analysis
showed a 19% decrease in cataracts among statin users
in observational studies [Kostis JB, Dobrzynski JM. J
Cardiovasc Pharmacol Ther. 2014]. Another, that examined the incidence of cataracts in 110,214 patients in 12
studies who received proprotein convertase subtilisinkexin type 9 (PCSK9) antibodies or statins, found that
they neither caused nor prevented cataracts. Sequential
analysis showed the same results; however, funnel plot
analysis, revealed the potential for publication bias.
Only 1 of the 12 studies indicated the potential for an
increase in cataracts with low LDL-C levels and only one
indicated a decrease in cataract with LDL-C lowering.
Meta-regression was essentially flat. In summary, based
on currently available information, there is no evidence
of a relationship between incidence of cataracts with
either statins or PCSK9 antibodies or with very low LDL
[Kostis JB et al. ESC Congress 2017. (Abstract 5967)].
Nevertheless, collection of data on cataracts in studies
of cholesterol-lowering medications under development
remains important.
Luiz Sérgio Carvalho, MD, PhD, State University of
Campinas, São Paulo, Brazil, presented a meta-analysis
showing that there a trend towards increased risk of
type 2 diabetes mellitus (T2DM) in patients achieving
very low levels of LDL-C.
Individuals with gain of function mutations in PCSK9
have reduced plasma levels of LDL-C, while loss of function mutations with PCSK9 are associated with more
LDL-C [Horton JD et al. J Lipid Res. 2009]. PCSK9 loss
of function mutations are also associated with increased
risk of prediabetes and diabetes [Ference BA et al. N Engl
J Med. 2016] by impairing ß-cell function [Rutti S et al.
Endocrinology. 2009]. With this background information,
Dr Carvalho's team conducted a systematic review and

In Review

meta-analysis of 20 high-quality randomised controlled
trials (RCTs) with PCSK9 inhibitors. The primary outcome
was change in HbA1c and fasting blood glucose from
baseline. Secondary outcomes included risk of incident
T2DM and/or worsening of T2DM during follow-up.
After a mean follow-up of 42 weeks, PCSK9 inhibition was associated with a 0.032% increase in HbA1c and
with a 1.88 mg/dL increase fasting plasma glucose (both
P < .001). PCSK9 inhibition did not increase or decrease
T2DM. The study was limited due to the rarity of the outcome and the relatively short-term follow-up. Although
the PCSK9 inhibitors increased plasma glycaemia and
HbA1c, the effect on T2DM was only apparent among
individuals who achieved very low levels of LDL-C after
treatment.
Akihiro Endo, MD, Shimane University Faculty of
Medicine, Division of Cardiology, Izumo, Japan, reported
that reducing LDL-C to < 70 mg/dL is effective for reducing the incidence of recurrent acute coronary syndrome
(ACS) in younger Japanese patients; however, a similar
effect was not found in elderly Japanese patients.
With the aging of the population, the number of
elderly patients with cardiac ischaemia is increasing.
LDL-C-lowering therapy with statins is effective for primary and secondary prevention of atherosclerotic cardiovascular diseases in Japanese patients [Nakamura
H et al. Lancet. 2006]. The target values are < 140 mg/dL
for primary prevention and < 100 mg/dL for secondary according to Japanese guidelines. Most RCTs have
excluded elderly patients, however.
The present study examined whether LDL-C lowering
with statins is equally effective in elderly and younger
patients with a history of percutaneous coronary intervention following recurrent cardiac ischaemia. The probability of freedom from recurrent ACS was significantly

Figure 1. Probability of Freedom From Recurrent Acute Coronary Syndrome

Elderly

Younger
(%)

Probability of Freedom From
Acute Coronary Syndrome

Probability of Freedom From
Acute Coronary Syndrome

(%)
80
60
40

LDL-C 70 to < 100 mg/dL
LDL-C < 70 mg/dL
LDL-C ≥100mg/dL

20
0

P = .863 (LDC-C ≥70mg/dL vs. 70 to < 100mg/dL)
P = .033 (LDC-C ≥100 mg/dL vs. 70 to < 100mg/dL)
0

No. at Risk
20
LDL-C < 70
LDL-C 70 to < 100 49
71
LDL-C ≥ 100

13
28
52

7
20
39

2
16
27

2
12
21

60

LDL-C 70 to < 100 mg/dL
LDL-C < 70 mg/dL
LDL-C ≥100mg/dL

40
20

P = .035 (LDC-C ≥70mg/dL vs. 70 to < 100mg/dL)
P = .955 (LDC-C ≥100 mg/dL vs. 70 to < 100mg/dL)

0

2
4
6
8
10
12
Interval From Last PCI to Late Coronary Angiography
20
41
66

80

(Years)

1
9
15

0
No. at Risk
23
LDL-C < 70
LDL-C 70 to < 100 60
81
LDL-C ≥ 100

2
4
6
8
10
12
Interval From Last PCI to Late Coronary Angiography
21
55
77

19
49
54

15
31
35

9
24
25

4
10
12

(Years)

3
8
5

ACS, acute coronary syndrome; LDL-C, low-density lipoprotein cholesterol.
Reproduced with permission from A Endo, MD.

Official Peer-Reviewed Highlights From ESC Congress 2017

27



Table of Contents for the Digital Edition of ESC Congress 2017 In Review -- Main Edition

Contents
ESC Congress 2017 In Review -- Main Edition - Cover1
ESC Congress 2017 In Review -- Main Edition - Cover2
ESC Congress 2017 In Review -- Main Edition - 1
ESC Congress 2017 In Review -- Main Edition - 2
ESC Congress 2017 In Review -- Main Edition - Contents
ESC Congress 2017 In Review -- Main Edition - 4
ESC Congress 2017 In Review -- Main Edition - 5
ESC Congress 2017 In Review -- Main Edition - 6
ESC Congress 2017 In Review -- Main Edition - 7
ESC Congress 2017 In Review -- Main Edition - 8
ESC Congress 2017 In Review -- Main Edition - 9
ESC Congress 2017 In Review -- Main Edition - 10
ESC Congress 2017 In Review -- Main Edition - 11
ESC Congress 2017 In Review -- Main Edition - 12
ESC Congress 2017 In Review -- Main Edition - 13
ESC Congress 2017 In Review -- Main Edition - 14
ESC Congress 2017 In Review -- Main Edition - 15
ESC Congress 2017 In Review -- Main Edition - 15A
ESC Congress 2017 In Review -- Main Edition - 15B
ESC Congress 2017 In Review -- Main Edition - 15C
ESC Congress 2017 In Review -- Main Edition - 15D
ESC Congress 2017 In Review -- Main Edition - 16
ESC Congress 2017 In Review -- Main Edition - 17
ESC Congress 2017 In Review -- Main Edition - 18
ESC Congress 2017 In Review -- Main Edition - 19
ESC Congress 2017 In Review -- Main Edition - 20
ESC Congress 2017 In Review -- Main Edition - 21
ESC Congress 2017 In Review -- Main Edition - 22
ESC Congress 2017 In Review -- Main Edition - 23
ESC Congress 2017 In Review -- Main Edition - 24
ESC Congress 2017 In Review -- Main Edition - 25
ESC Congress 2017 In Review -- Main Edition - 26
ESC Congress 2017 In Review -- Main Edition - 27
ESC Congress 2017 In Review -- Main Edition - 28
ESC Congress 2017 In Review -- Main Edition - 29
ESC Congress 2017 In Review -- Main Edition - 30
ESC Congress 2017 In Review -- Main Edition - 31
ESC Congress 2017 In Review -- Main Edition - 32
ESC Congress 2017 In Review -- Main Edition - Cover3
ESC Congress 2017 In Review -- Main Edition - Cover4
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