Στο πρόσφατο συνέδριο της Ευρωπαϊκής Καρδιολογικής Εταιρείας (ESC, European Sociaty of Cardiology) που έλαβε χώρα στην πόλη του Άμστερνταμ, συναντήθηκαν, όπως κάθε χρόνο, σημαντικοί επιστήμονες διαφορετικών ειδικοτήτων από όλα τα μέρη του κόσμου με ενδιαφέρον για το χώρο της προληπτικής καρδιολογίας. Οι επιστημονικές ζυμώσεις και η ανταλλαγή απόψεων και νεότερων στοιχείων με επίκεντρο τον υπολειπόμενο καρδιαγγειακό κίνδυνο ήταν στο επίκεντρο του ενδιαφέροντος φέτος.
Εκτός λοιπόν από την LDL («κακή») χοληστερόλη και τις νέες φαρμακευτικές επιλογές για την ελάττωσή της, στο συζήτηση έχουν προστεθεί και άλλες λιπιδαιμικές παράμετροι [τριγλυκερίδια, λιποπρωτεϊνη (α) – Lp (a), HDL-C], καθώς και δείκτες φλεγμονής [υψηλής ευαισθησίας CRP (hs CRP), ιντερλευκίνη-6 (IL-6) κλπ.].
Για την περαιτέρω ελάττωση της LDL-C, ο νεότερος αναστολέας της CETP Obicetrapib, έχει δείξει βιοχημική αποτελεσματικότητα και ασφάλεια στις μελέτες ROSE και ROSE2. Το επερχόμενο πρόγραμμα μελετών (PREVAIL, BROADWAY, BROOKLYN) έχει σχεδιαστεί με στόχο να αποδείξει κλινικό όφελος στην καρδιαγγειακή νοσηρότητα και θνητότητα.
Στην αναστολή της PCSK9, εκτός από τα μονοκλωνικά αντισώματα Alirocumab και Evolocumab με την τεκμηριωμένη κλινική αποτελεσματικότητα, έρχεται να προστεθεί το Inclisiran, ένα μικρό παρεμβαλόμενο RNA με αραιά δοσολογικά σχήματα (ανά εξάμηνο), για το οποίο αναμένονται αποτελέσματα καρδιαγγειακής προστασίας με τη μελέτη HORIZON.
Το Icosapent Ethyl αποτελεί μια καθαρή χημική μορφή αιθυλικού εστέρα του εικοσαπενταϊκού οξέος (ΕΡΑ) και ελαττώνει τα επίπεδα τριγλυκεριδίων ορού. Στη μελέτη REDUCE-IT το σκεύασμα αυτό πέτυχε ελάττωση του καρδιαγγειακού κινδύνου κατά 25% σε ασθενείς υψηλού κινδύνου με υπερτριγλυκεριδαιμία και επίπεδα LDL-χολ <100 mg/dL παρά τη λήψη στατίνης. Το φάρμακο θα είναι σύντομα διαθέσιμο και στη χώρα μας.
Τέλος, ανακοινώθηκε ο σχεδιασμός της μελέτης ZEUS με τον αντιφλεγμονώδη παράγοντα Ziltivekimab που αποτελεί αναστολέα της IL-6. Στη μελέτη θα φανεί αν η χορήγηση του υπό μελέτη φαρμάκου σε πάσχοντες από καρδιαγγειακή νόσο, χρόνια νεφρική νόσο και αυξημένα επίπεδα φλεγμονής οδηγεί σε ελάττωση του κινδύνου εμφάνισης καρδιαγγειακών επεισοδίων.
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