MOESM1 of Bibliometric analysis of rheumatology research in the Arab countries

Additional file 1: Table S1A. Estimated disability adjusted life years (DALY) for non-communicable disease (2012) for all ages. Table S1B. Estimated disability adjusted life years (DALY) for non-communicable disease 560 (2012) for ages 30–59. Table S2. Raw data based on all paper type categories listed in Medline. Annex S1.All searches in the Web of Science Core Collection were restricted by Document Type=(Article) and Timespan=(1975–2014)

LDL-C Targets in Secondary Prevention: How Low Should We Go?

The benefits of lowering low-density lipoprotein cholesterol (LDL-C), mainly using high-intensity statin therapy, and its impact on decreasing the recurrence of atherosclerotic cardiovascular disease (ASCVD) in secondary prevention has been well established. With the advent of non-statin medications, particularly PCSK-9 inhibitors, which can lower LDL-C to very low levels not seen before, it is important to answer some important questions regarding LDL-C lowering and the uses of these medications in clinical practice: how low should we go with LDL-C reduction? Is there a threshold beyond which lower LDL-C is not associated with any benefit and possibly harm? Does the benefit derived from more aggressive LDL-C lowering justify the cost of additional therapies? Our review has found overwhelming evidence to support the conclusion that lower achieved LDL-C levels correlate with a decreased burden of atherosclerosis and better clinical outcomes in secondary prevention. The concern for adverse effects with very low LDL-C levels is not backed by the literature, and side effects appear to be medication-specific. There still remains a question of the cost-effectiveness of some non-statin therapies particularly PCSK9 inhibitors, in spite of recent price decreases, and whether the benefit is worth the cost. It is prudent to always pursue an individualized patient-level approach to LDL-C lowering that considers the patient’s global cardiovascular risk, their side effect profile, and the cost-effectiveness of therapies in order to derive maximal benefit from aggressive lipid lowering.Other Information Published in: Current Cardiovascular Risk Reports License: https://creativecommons.org/licenses/by/4.0See article on publisher's website: http://dx.doi.org/10.1007/s12170-019-0619-8</p