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iwMPN 2025 | Prevention strategies for patients with MPNs at high risk of cardiovascular disease
Alexander Lyon, MA, BM, BCh, PhD, FRCP, FHFA, Royal Brompton Hospital, London, UK, comments on the use of vascular risk scores to identify patients with myeloproliferative neoplasms (MPNs) at high risk of cardiovascular disease and the importance of intensifying treatments for these patients. Dr Lyon gives guidance for prevention strategies dependent on low, intermediate, or high-risk. This interview took place at the 3rd International Workshop on Myelodysplastic Syndromes & Myeloproliferative Neoplasms (iwMDS & iwMPN) 2025, held in Lisbon, Portugal.
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Transcript
So we use these 10-year vascular risk scores, the SCORE2 and JBS3 and Q-RISK scores in the UK, and then other risk scores around the world that have generally been validated in different populations to look at 10-year risk. And then we have the low, the intermediate, and the high risk. For intermediate and high risk patients they should be on statin therapy if not already and then for the high and people with secondary prevention strategies they’ve already presented with vascular disease that’s where we’re looking at intensifying treatments potentially adding a low-dose rivaroxaban to the aspirin and adding a PCSK9 inhibitor to their statin or if they can’t take statins, 10% of people are intolerant...
So we use these 10-year vascular risk scores, the SCORE2 and JBS3 and Q-RISK scores in the UK, and then other risk scores around the world that have generally been validated in different populations to look at 10-year risk. And then we have the low, the intermediate, and the high risk. For intermediate and high risk patients they should be on statin therapy if not already and then for the high and people with secondary prevention strategies they’ve already presented with vascular disease that’s where we’re looking at intensifying treatments potentially adding a low-dose rivaroxaban to the aspirin and adding a PCSK9 inhibitor to their statin or if they can’t take statins, 10% of people are intolerant. Then we’ve got an oral alternative bempedoic acid. This is slightly weaker than statins, about 25-30% reduction in LDL cholesterol. But the PCSK9 inhibitors are 70%, and with bempedoic acid, you get down to 90%. So in my practice, I’ve seen some amazingly low cholesterols in high-risk patients with a PCSK9 inhibitor plus either a statin or bempedoic acid, depending on their previous experience with statins. So this is modern cardiology and prevention now being introduced into these hematology patients who are very high risk.
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