Dyslipidemia management in terms of cardiovascular prevention?

Olivier S. Descamps, Patrick Chenu Published in the journal : November 2016 Category : GRAPA

Summary :

Lipid management for cardiovascular disease prevention has significantly evolved over the last 20 years, and each novel recommendation brings about new proposals to further improve our patients’ prognosis. The latest 2016 guidelines overlap quite well with those of 2011, stressing once more the relevance of correcting promptly the LDL-cholesterol levels by means of first-line statin therapy. These updated guidelines, however, do define more precisely the LDL-cholesterol levels to target in very-high-risk patients, and the non-HDL cholesterol levels to target in moderate-risk patients. To achieve these targets, they also emphasize the need to combine ezetimibe with statins. Yet over the last years, the implementation of these recommendations has been threatened owing to various controversies casting doubt on statins' safety and usefulness. On account of the introduction of new anti-PCSK9 monoclonal antibodies, familial hypercholesterolemia treatment has now returned to the forefront. These new treatments, along with the more conventional agents, should enable us, at last, to correct the severely-high LDL-cholesterol levels exhibited by these patients from birth onwards. This article briefly addresses these various topics, which are detailed, point-by-point, in the following Louvain Médical issue.

What is already known about the topic?

Guidelines on lipid management for preventing cardiovascular diseases have been recommending for many years to firstly correct LDL-cholesterol levels using statins in first line.

What does this article bring up for us?

- While the latest 2016 recommendations reinforce this message, they more precisely define the LDL
-cholesterol and non-HDL cholesterol levels to target, emphasizing the need to combine ezetimibe with statins to achieve these goals.
- Besides the conventional barriers to prevention, statins have aroused serious controversy over the last years. - With the introduction of new anti-PCSK9 antibodies, familial hypercholesterolemia has been given further attention, with special emphasis put on improving its screening.

Key Words

Cardiovascular disease, cardiovascular prevention, lipoproteins, LDL cholesterol, atherosclerosis