- N Engl J Med 2022; 386:e58
A 27-year-old man presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. Pink-yellow papules were seen on examination. A blood sample was grossly lipemic.
- N Engl J Med 2022; 386:2129-2129
A 34-year-old woman presented with a 4-year history of progressive skin lesions and 3-month history of weight loss. Physical examination showed a symmetric distribution of clusters of pink-yellow papules that merged into branching projections on the trunk, buttocks, and all four limbs.
- N Engl J Med 2022; 386:2024-2034
Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.
- N Engl J Med 2022; 386:1265-1265
A 63-year-old man undergoing stenting of the left common carotid artery had shivering, sweating, and confusion, as well as livedo reticularis on the left side of his face. Cholesterol embolization syndrome was diagnosed.
A Half-Century of Progress in Health: The National Academy of Medicine at 50: Conquering Atherosclerotic Cardiovascular Disease — 50 Years of ProgressN Engl J Med 2021; 384:785-788
Substantial reductions in cardiovascular mortality in the United States reflect the power of a system that catalyzes the integration of basic science, translational research, technological innovation, evidence-based public policy, and public health practice.
- N Engl J Med 2021; 384:216-228
Participants without cardiovascular disease who were at increased risk were randomly assigned to receive a polypill (containing a statin and three blood-pressure–lowering drugs) or placebo and to receive aspirin or placebo. At 4.6 years, the incidence of cardiovascular events was lower among participants receiving both the polypill and aspirin than...
- N Engl J Med 2021; 384:288-289
The polypill concept garnered substantial attention in 2003 after the publication of a modeling analysis that proposed that the use of fixed-dose combination therapy in persons with established atherosclerotic cardiovascular disease and in all other adults 55 years of age or older could reduce disease burden by 80% or more.
- N Engl J Med 2020; 383:2307-2319
Angiopoietin-like 3 is an inhibitor of lipoprotein lipase. Evinacumab is a monoclonal antibody that inhibits angiopoietin-like 3, activating lipoprotein lipase. In patients with hypercholesterolemia that is refractory to statin and PCSK9 inhibitor therapy, the use of evinacumab reduced plasma lipid levels by more than 50% at the maximum dose.
- N Engl J Med 2020; 383:2385-2386
Patients with familial hypercholesterolemia, who have a severely increased low-density lipoprotein (LDL) cholesterol level from birth and are at high risk for premature cardiovascular disease, have inspired and contributed to major advances in lipid therapeutics. A notable example is the drug class targeting proprotein convertase subtilisin–kexin type 9 (PCSK9). Overactivity...
- N Engl J Med 2020; 383:2182-2184
Patients who had discontinued statins because of side effects received four bottles of a statin, four bottles of placebo, and four empty bottles, each to be used for 1 month in a random sequence for 12 months. The symptom burden with placebo was 90% of the symptom burden with the...
- N Engl J Med 2020; 383:1317-1327
In a 24-week, randomized, placebo-controlled trial, evolocumab, a fully human anti-PSCK9 monoclonal antibody, was studied in pediatric patients who had heterozygous familial hypercholesterolemia and were receiving stable lipid-lowering treatment. Evolocumab reduced the LDL cholesterol level and other lipid variables.
- N Engl J Med 2020; 383:1385-1386
Heterozygous familial hypercholesterolemia — in contrast to the more rare and more severe homozygous familial hypercholesterolemia — is a common genetic cholesterol disorder affecting approximately 1 in 250 persons and resulting in an increased risk of premature atherosclerotic cardiovascular disease.1 Autopsies and subclinical vascular studies indicate that childhood...
- N Engl J Med 2020; 383:775-776
Several drug options are available for patients with an elevated plasma cholesterol level who are at increased risk for a cardiovascular event. These drugs, which include selective cholesterol-absorption inhibitors and PCSK9 inhibitors as well as statins, effectively lower plasma cholesterol levels in most patients. Unfortunately, these therapeutic options are much...
- N Engl J Med 2020; 383:711-720
Among 65 patients with homozygous familial hypercholesterolemia, the use of evinacumab, a monoclonal antibody against ANGPTL3, resulted in a reduction from baseline in the LDL cholesterol level, as compared with a small increase with placebo, for a between-group difference of 49.0 percentage points at 24 weeks.
- N Engl J Med 2020; 382:1520-1530
This phase 3 trial evaluated the safety and efficacy of inclisiran, a small interfering RNA that inhibits hepatic PCSK9 synthesis, in 482 adults with heterozygous familial hypercholesterolemia, who received subcutaneous injections of inclisiran or placebo on days 1, 90, 270, and 450. Changes in cholesterol were assessed up to day...
- N Engl J Med 2020; 382:1507-1519
Inclisiran, a small interfering RNA therapeutic, reduces hepatic synthesis of PCSK9. In two separate randomized trials, subcutaneous injections of inclisiran on day 1, day 90, and then every 6 months reduced LDL cholesterol levels by approximately 50% at month 17, with a modest excess of injection-site adverse events.
- N Engl J Med 2020; 382:9-19
In this trial, patients with stroke or TIA and atherosclerosis who received a statin with or without ezetimibe were randomly assigned to an LDL cholesterol target of less than 70 mg per deciliter or to a target range of 90 to 110 mg per deciliter. At a median follow-up of...
- N Engl J Med 2020; 382:81-82
Elevated levels of cholesterol are a well-known risk factor for cardiovascular disease, including stroke, and efforts to lower cholesterol levels to reduce risk have been ongoing for decades. Because of their dramatic effect on cholesterol, statins have been widely prescribed to prevent cardiovascular events in patients at high risk. Most...
- N Engl J Med 2019; 381:1547-1556
Familial hypercholesterolemia is marked by very elevated low-density lipoprotein cholesterol levels and premature cardiovascular disease. This 20-year follow-up study showed that statin initiation during childhood in affected persons slowed the progression of carotid intima–media thickness and reduced the risk of cardiovascular disease in adulthood.
- N Engl J Med 2019; 381:1557-1567
Management of serum cholesterol level is a central objective in preventing cardiovascular events. Current guidelines recommend calculation of cardiovascular risk, with treatment decisions based on these data and clinician–patient discussion of risk. Statins remain the first line of pharmacotherapy.