Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force.

Abstract

BACKGROUND AND AIMS:

This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in high-risk and very-high-risk patients.

METHODS:

Evidence-based review.

RESULTS:

Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro- and microvascular benefits in patients with type 2 diabetes mellitus.

CONCLUSIONS:

This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.

• Authors: Maurizio Averna, Maciej Banach, Eric Bruckert, Heinz Drexel, Michel Farnier, Dan Gaita, Paolo Magni, Winfried März, Luis Masana, Alberto Mello E Silva, Zeljko Reiner, Emilio Ros, Michal Vrablik, Alberto Zambon, Jose L Zamorano, Jane K Stock, Lale S Tokgözoğlu, Alberico L Catapano
• Journal: Atherosclerosis (Atherosclerosis) Vol. 325 Pg. 99-109 (05 2021) ISSN: 1879-1484 [Electronic] Ireland
• PMID: 33892925 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021. Published by Elsevier B.V.

Chemical References

• Anticholesteremic Agents
• Cholesterol, LDL
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• PCSK9 protein, human
• Proprotein Convertase 9

Topics

• Anticholesteremic Agents
• Atherosclerosis (drug therapy, prevention & control)
• Cholesterol, LDL
• Diabetes Mellitus, Type 2
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Proprotein Convertase 9