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      NSC The M.D.Strazhesko Institute of Cardiology NAMS of Ukraine
      European Atherosclerosis Society (EAS)
      International Atherosclerosis Society (IAS)
      Ukrainian Antihypertensive Society

    87th EAS Congress


    Dear colleagues,
    Let's look at the highlights of the 87th Congress of the European Society for Atherosclerosis.

    Remembering the 4th day of Congress EAS in Maastricht, 2019

    From the plenary session on Wednesday May 29

    Looking to the future novel treatment strategies
    The final Plenary session gave a dynamic overview of the future for therapeutic strategies, in which both the immune system and lipoproteins feature.

    Laszlo Nagy
    Opening this session, Professor Laszlo Nagy (Johns Hopkins University School of Medicine, Baltimore, Maryland, USA) discussed researches implicating the immune system in muscle regeneration and repair. Macrophages play a pivotal role in this process, initially as inflammatory mediators that help to clear necrotic debris, and subsequently transitioning to repair macrophages involved in the tissue repair and remodelling processes.1System level approaches, involving a combination of epigenomics, transcriptomics and lipidomics, helped to define critical effectors of this macrophage plasticity that occurs in response to specific environmental cues. Studies identified BACH1 and PPAR? as key transcription factors involved in this phenotypic switch mediated via lipid signalling that controls the expression of final effectors such as HOX1 (via BACH1) and GFD3 (via PPAR?). Shotgun and targeted lipidomics also identified resolvin D2 as critically involved in in promoting muscle repair process. Taken together, these findings implicate innate immune cells with dynamic lipid mediator signatures in the muscle repair process. Targeting key effectors of this metabolic regulation may offer therapeutic potential not only in muscle regeneration disorders, but also in diabetes, the latter possibly via the involvement of PPAR?.

    Back to lipids

    Erik Stroes
    With the advent of the PCSK9 inhibitors, attainment of very low LDL-C levels now becomes feasible, implying that the time has now come for researchers to turn their attention to other novel targets. Professor Erik Stroes (Amsterdam Medical Center, University of Amsterdam, the Netherlands) discussed apolipoprotein-B containing lipoproteins worthy of contention. Mendelian randomisation studies have validated three potential targets: apo-CIII for triglyceride-rich lipoproteins, apo(a) contained within lipoprotein(a) and angiopoietin like protein 3 (ANGPTL3).
    Recent data have established that the clinical benefit from lowering apoB-containing lipoproteins is directly related to the absolute reduction in apoB. However, there appears to be a discordance between the magnitude of reduction of triglycerides observed in clinical trials (ranging from 15% to 80%, depending on the drug) and that observed for apoB (5-10%). An exception to this is represented by early clinical trials targeting ANGPTL3, where a comparable and extensive reduction in apoB and triglycerides was observed with the anti ANGPTL3 monoclonal antibody evinacumab in a pilot study in patients with homozygous familial hypercholesterolaemia.7 The mechanism of this effect merits further investigation, but appears to involve lowering of both triglycerides and cholesterol.
    In a setting of finite healthcare resources, it will be become increasingly important to target these costly treatments to patients at highest absolute cardiovascular risk who are likely to benefit most from these treatments. Clinicians will require an improved framework to optimise clinical decision-making, integrating information from biomarkers, genetics and imaging. Ultimately, implementation will require the combination of machine learning, to achieve cost-effective use of highly efficacious but costly therapies in cardiovascular medicine.

    The third day of the Congress EAS 2019, Tuesday, May 28

    From the plenary session on Tuesday

    Preventing cardiovascular disease risk where do we stand?

    Expanding knowledge about a myriad of risk factors including biomarkers, genetics and imaging, together with recognition that there is unite funding for healthcare systems, argues for new thinking about cardiovascular disease risk prevention. This background provided the basis for pertinent discussions around key issues in this plenary.

    Chris Packard
    Leading the session, Professor Chris Packard (University of Glasgow, UK) made a case for reconsidering the framework of biomarkers based on their utility. He proposed that biomarkers should be categorised as either 1) causal, with low-density lipoprotein cholesterol (LDL-C), the benchmark for this group,1 2) systems biomarkers such as C-reactive protein, fibrinogen, apolipoprotein (apo) CIII, nonfasting triglycerides and insulin resistance, which report on the state of a system but may not be directly involved in atherogenesis; or 3) disease progression biomarkers such as high-sensitivity troponin T and I and NT-proB-type Natriuretic Peptide which inform about the state of the myocardium, and when combined with classical biomarkers improve the ability to predict coronary disease, heart failure and peripheral vascular disease.2 Using this framework, he suggested a new paradigm for cardiovascular disease prevention similar to that used in other disciplines such as oncology and infection, involving episodic intensive lowering of plasma LDL-C specifically targeting younger adults in the primary prevention setting to drive down levels until early atherosclerotic lesions have resolved, followed by a subsequent maintenance phase in which LDL-C levels <2.6 mmol/L are tolerated. Such an approach has the potential to limit clinical atherosclerotic cardiovascular disease events later in life and confer socioeconomic benefit. This approach would also obviate the need for adherence to lifelong lipidlowering drug therapy in most individuals and minimise safety considerations.

    Heribert Schunkert
    However, there are other components of risk that need to be incorporated as discussed by Professor Heribert Schunkert (Technische Universitaet Munich,Germany). Genetic risk may be attributed to both rare variants with large effects and common small-effect variants. The latter has a profound impact on risk at the population level, and therefore prevention strategies should aim to neutralise these risk alleles. Incorporation of polygenic risk scores which identify those individuals with risk equivalent to monogenic mutations was suggested.3 Genetic information will also help in resolving causal mechanisms implicated in atherosclerosis, even lifestyle which is at least partly determined by genetics.

    Kausik Ray
    Failure to diagnose familial hypercholesterolaemia results in worse outcome
    Results from an analysis of more than 1.7 million patient records show that patients who are likely to have familial hypercholesterolaemia (FH, inherited high cholesterol) based on cholesterol and family history criteria, but are not diagnosed as FH, are twice as likely to die earlier than individuals who have a FH diagnosis.1 The study was reported by Professor Kausik Ray (Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, UK).

    Professor Paul Ridker discusses inflammation inhibition and atherothrombosis.
    Whether systemic inflammation is a marker or mediator of atherothrombosis has engendered much debate in the past. However, the CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) changed this.1 In patients managed with best evidence-based therapy, including very well controlled low-density lipoprotein cholesterol (LDL-C) levels at baseline, treatment with canakinumab, a monoclonal antibody to interleukin-1? (IL-1?), resulted in profound reduction in the high-sensitivity C-reactive protein levels (by 37 and 41% with the two higher doses, 150 mg and 300 mg), and this was associated with significant reduction in major adverse cardiovascular events. Importantly, this benefit was independent of any change in plasma LDL-C levels. CANTOS was truly a proof-of-concept study that irrevocably changed thinking about inflammatory risk.
    Secondary analyses of the CANTOS study showed that patients who achieved lower levels of hs-CRP or IL-6 following the therapy with canakinumab derived greater cardiovascular benefit, also in terms of cardiovascular and all-cause mortality.

    Remembering the 2nd day of Congress EAS in Maastricht, 2019

    Plenary meeting on Monday May 27, 2019:
    Novel insights into metabolic dysfunction in cardiovascular disease

    Klaus Ley
    The Monday plenary focused on metabolic dysfunction, with ensuing discussion of potential targets in that may offer potential for therapeutic intervention.
    Opening the session, Professor Klaus Ley (La Jolla Institute for Allergy and Immunology and Adjunct Professor of Bioengineering at the University of California, San Diego, USA) suggested a role for olfactory receptors in mediating atherosclerosis.

    Piter Carmeliet
    Following on, Professor Peter Carmeliet (Katholieke Universiteit Leuven, Belgium), a past Anitschkow Award recipient (Innsbruck 2016), revisited angiogenesis, specifically focusing on the role of endothelial metabolism and heterogeneity
    Read the full report on Monday's plenary :

    Section sessions on familial hypercholesterolemia, PCSK9 inhibitors and bempedoic acid feature

    The first late breaking session on Monday highlighted new therapeutic approaches focused on lowering low-density lipoprotein cholesterol (LDL-C). Among the studies reported was the ORION-2 study with inclisiran in homozygous familial hypercholesterolaemia (FH, inherited high cholesterol), a novel anti-PCSK9 agent LIB003, and a fixed combination of bempedoic acid and ezetimibe. In addition, there were important insights from a new analysis of the Scandinavian Simvastatin Survival Study (4S), a gamechanger for statin therapy in the secondary prevention.

    Read the full report on the sessions Monday:

    The first day, May 26, 2019.

    Opening the Congress, EAS President Professor Lale Tokgozoglu (Ankara, Turkey) highlighted the role of the Society in research, education and collaboration. The new Joint Dyslipidaemia Guidelines with the European Society of Cardiology are eagerly anticipated later this year, in the light of recent findings from major trials of innovative therapies.


    The pinnacle of the Opening Ceremony, however, is the Anitschkow Lecture, which this year was given by Anitschkow Award recipient, Professor Helen Hobbs, an international leader in research defining the genetic determinants of plasma lipid levels and cardiovascular risk. Professor Hobbs lecture was a tour de force of her research career, illustrating the value of the rare genetic concept, initially from work within the Dallas Heart Study, and then extending to collaborations around the world.

    The Anitschkow Lecture - Helen Hobbs

    Lipids in the wrong places ...

    The value of lipoprotein (a)

    The difference in the levels of LDL cholesterol in men in the United States and China

    From genetics to public health
    - Dallas Heart Study

    Post-meal dislipidemia (Nonfasting) and fasting dislipidemia

    The pathway for the formation of non-alcoholic fatty liver disease
    obesity and insulin resistance

    Parallels between non-alcoholic fatty liver disease and coronary pathology

    Genetic marking of atherosclerosis and non-alcoholic fatty liver disease

    The main result of the study was the discovery of the genetic and population relationship of the formation of atherosclerosis and non-alcoholic fatty liver disease in patients with obesity.

    Official website:

    Dear colleagues,

    Let us inform you about the next scientific and informational events of the Ukrainian Atherosclerosis Society scheduled in 2019 as well.

    We invite you to meet the Ukrainian Lipid School:

    Ukrainian Lipid School

    • April 19 in Chernivtsy (venue - Academy Palace).

    • Two subsequent meetings of the Lipid School will take place in the fall of 2019 (additional information will be provided).

    Also, let us announce events of the Ukrainian Atherosclerosis Society included in the general register of congresses and conferences in Ukraine at 2019:

    • On October 17, 2019, the Conference "Gender aspects of cardiometabolic risk in women" will be held in Dnipro City.

    • On November 13, 2019, the XIII Annual Meeting of the Ukrainian Atherosclerosis Society "Diagnosis, prevention and treatment of atherosclerosis and coronary heart disease: modern approaches and new achievements" will take place in Kyiv.

    29th European Meeting on Hypertension & Cardiovascular Protection,2019/06/21-24

    ESC Congress,2019/08/31-09/04

    20-th National Congress of Cardiologists of Ukraine, Kyiv, 2019/09/25-27


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