The latest guidelines, issued in August 2016 by both the European society of cardiology and European atherosclerosis society, have shed light on the therapeutic means to be implemented in order to achieve the cardiovascular risk-based lipid targets. The dietary recommendations focusing on the reduction of saturated fatty acid intakes, along with the increased consumption of grain products, vegetables, fruits, and fish, remain essential for an optimal preventive approach to cardiovascular diseases. Their benefits extend well beyond their measurable effects on the lipid profile. If these measures prove insufficient, they should be complemented by drug therapy in high-risk patients. In very-high-risk patients (e.g., with cardiovascular disease, diabetes, or renal insufficiency), drug therapy is, however, added immediately, irrespective of dietary compliance. Statins are the first-line agents for reducing LDL-cholesterol levels and must be chosen and prescribed to the required dose in order to achieve the predetermined target. Ezetimibe can be administered in combination with a statin to better reach these targets or in the event of intolerance to high statin doses. Second-line treatments, including ezetimibe, fibrates, or omega-3 supplementation in addition to ongoing statin therapy, are aimed at correcting non-HDL cholesterol levels. The introduction and reimbursement of these new drugs will likely complement these therapeutic tools.
What is already known about the topic?
- Statins and ezetimibe have proven effective for correcting LDL-cholesterol levels and reducing cardiovascular risk.
- The aim is to achieve non-HDL-cholesterol and LDL-cholesterol levels below the cardiovascular risk-based targets.
What does this article bring up for us?
- Statins, whether combined or not with ezetimibe, are the first-line treatments for correcting LDL-C level in terms of cardiovascular prevention.
- For second-line, correcting non-HDL-C levels may require the combination of ezetimibe with a statin (if not yet done), fibrate, or omega-3 fatty acids at pharmacological dosages.
Key Words
Cardiovascular diseases, cardiovascular prevention, lipoproteins, LDL-cholesterol, atherosclerosis.