University of Cambridge
Centre for Naturally Randomized Trials, School of Clinical Medicine
Brian is a cardiologist and genetic epidemiologist who was educated and trained at Harvard, Yale, Oxford and Cambridge Universities. He graduated from Yale Medical School and trained as a clinical investigator resident in Internal Medicine and as a special student in clinical epidemiology and genetic epidemiology as part of the Robert Wood Johnson Clinical Scholars Program at Yale. He then trained in cardiology and interventional cardiology at Harvard Medical School. While at Harvard, he also completed the Program in Clinical Effectiveness at Harvard School of Public Health, and was an NHLBI Cardiovascular (Genetic) Epidemiology Fellow at the Brigham and Women’s Hospital and Harvard Medical School. He then earned a business degree from the University of Cambridge, and a degree in evidence-based medicine with a focus on clinical trial design from the University of Oxford He is currently Professor and Director of Research in Translational Therapeutics, and Head of the Centre for Naturally Randomized Trials at the University of Cambridge, UK. His previous positions included Chief of Cardiology at a US University; Chief Medical and Scientific Officer for a public-private collaboration working on the Chinese Precision Medicine Initiative in Beijing; and CEO of a biotechnology company.

Presenter of 5 Presentations

Cumulative exposure, estimating benefits of early invention of lifetime risk

Session Type
Parallel Session
Date
Mon, 23.05.2022
Session Time
14:50 - 15:35
Room
Anitschkow - Silver Plenary hall
Lecture Time
15:20 - 15:30

Reimagining prevention - Using AI and causal estimates to preserve health?

Session Type
CME Session
Date
Sun, 22.05.2022
Session Time
17:00 - 18:15
Room
Rodolfo Paoletti - Red room
Lecture Time
17:00 - 17:25

Moving towards personalised prevention, Individual susceptibility?

Session Type
Parallel Session
Date
Tue, 24.05.2022
Session Time
11:00 - 12:30
Room
Attilio Maseri - Blue room
Lecture Time
11:00 - 11:15

What is new in prevention in apparently healthy persons?

Session Type
Joint Session
Date
Mon, 23.05.2022
Session Time
11:00 - 12:30
Room
Anitschkow - Silver Plenary hall
Lecture Time
11:20 - 11:40

ESTIMATING THE MAGNITUDE OF LDL-C REDUCTION NEEDED TO OVERCOME THE INCREASED RISK OF ATHEROSCLEROTIC CARDIOVASCULAR EVENTS CAUSED BY LP(A) TO GUIDE CLINICAL MANAGEMENT

Session Type
Parallel Session
Date
Tue, 24.05.2022
Session Time
15:45 - 17:15
Room
Piero Avogaro - Yellow room
Lecture Time
15:55 - 16:05

Abstract

Background and Aims

Lp(a) increases the risk of atherosclerotic cardiovascular (CV) disease. Current guidelines suggest controlling other CV risk factors, such as LDL-C levels, more intensively in order to reduce the increased risk associated with elevated Lp(a). Therefore, to guide clinical management, we sought to evaluate the magnitude of LDL-C reduction needed to overcome the increased CV risk caused by Lp(a).

Methods

A total of 445,744 UK-Biobank participants were included in the study (mean age: 57.3 years; female sex: 54.3%). We plotted the trajectories of the lifetime risk of major coronary events (a composite of fatal or non-fatal myocardial infarction, or coronary revascularization) associated with increased Lp(a) levels and the equivalent changes in LDL-C levels required to overcome the increased risk caused by various Lp(a) levels.

Results

Our results provide a quantitative estimate of how much LDL-C must be reduced to overcome the increased risk specifically caused by any level of Lp(a). In the table the LDL-C reduction needed to overcome the increased risk caused by Lp(a) is reported based on Lp(a) levels and the age at which LDL-C lowering is started. Notably, the magnitude of LDL-C reduction needed to overcome the increased risk caused by Lp(a) increases with the age at which LDL-C lowering is initiated.

table.jpg

Conclusions

Although no therapies lower Lp(a) specifically, the increased risk caused by Lp(a) can be overcome with additional LDL-C lowering that depends on a person’s Lp(a) level and the age at which LDL-C lowering is started. Our results provide practical guidance for managing increased CV risk caused by Lp(a).

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