Changing Landscape of Modifiable Cardiovascular Risk Factors, with Payal Kohli, MD

The idea of what are considered “modifiable” cardiovascular risk factors has undergone a revolution in recent decades thanks to improvements in understanding of pathophysiology and disease course that has been mirrored by advancements in pharmacologic therapy.

In 2023, the field saw the first approval of an anti-inflammatory atheroprotective cardiovascular treatment in colchicine 0.5 mg (Lodoco) tablets, which received approval from the US Food and Drug Administration (FDA) in June 2023 for reducing the risk of myocardial infarction, stroke, coronary revascularization, and cardiovascular death in adult patients with established atherosclerotic disease or with multiple risk factors for cardiovascular disease. Continuing evidence of this progress, in the first 3 months of 2024 another pair of agents received historic indications from the FDA.

On March 08, 2024, semaglutide 2.4 mg (Wegovy) became first treatment approved for reducing cardiovascular risk specifically for patients with overweight or obesity. On March 22, 2024, label expansions for bempedoic acid (Nexletol) and bempedoic acid with ezetimibe (Nexlizet) to include primary and secondary prevention of cardiovascular risk made the agent the first LDL-C-lowering non-statin agent to receive a primary prevention indication.

The next risk factor in the crosshairs of the community is lipoprotein(a) [Lp(a)]. For lipidologists, Lp(a) has risen in prominence as a prognostic factor for determining future cardiovascular risk, but several novel agents, including olpasiran, pelacarsen and SLN360,have brought forth promising data suggesting the community may soon be equipped with an agent indicated for reducing Lp(a).

Even with this sheer level of advancement, most in cardiology will admit the greatest influence over uptake of these agents and application of this improved understanding of pathophysiology of cardiovascular disease are their colleagues within primary care and internal medicine.

With an interest in spotlighting the advancements in the therapeutic pipeline and how the evolving definition of what is considered a “modifiable” cardiovascular risk factor, we sat down with Payal Kohli, MD, associate clinical professor of Medicine at the University of Colorado Anschutz and medical director of Cherry Creek Heart, for further insight into how these changes effect healthcare.

Relevant disclosures for Kohli include Agepha Pharma, Amarin, Amgen, AstraZeneca, Novartis, Merck, and others.

References:

1. Campbell P. FDA approves colchicine tablets for reducing cardiovascular risk. HCPLive. June 20, 2023. Accessed May 3, 2024. https://www.hcplive.com/view/fda-approves-colchicine-tablets-for-reducing-cardiovascular-risk.
2. Esperion Therapeutics. US FDA Approves Broad New Labels for Nexletol® and Nexlizet® to Prevent Cardiovascular Disease. Esperion Therapeutics. Accessed May 2, 2024. https://www.esperion.com/news-releases/news-release-details/us-fda-approves-broad-new-labels-nexletolr-and-nexlizetr-prevent.
3. Campbell P. Semaglutide (Wegovy) receives FDA label expansion to include cardiovascular risk reduction. HCPLive. March 8, 2024. Accessed May 3, 2024. https://www.hcplive.com/view/semaglutide-wegovy-receives-fda-label-expansion-to-include-cardiovascular-risk-reduction.
4. Nurmohamed NS, Kraaijenhof JM, Stroes ESG. Lp(a): a New Pathway to Target?. Curr Atheroscler Rep. 2022;24(11):831-838. doi:10.1007/s11883-022-01060-4