Statins are first-line agents in patients with dyslipidemia, with established benefits for reducing low-density-lipoprotein cholesterol (LDL-C) levels and cardiovascular events. However, a considerable number of statin-treated patients do not achieve target LDL-C levels, even at maximally tolerated statin doses, or are intolerant to intensive statin therapy. These patients can benefit from the addition of a non-statin lipid-lowering agent, and recent cholesterol guidelines have placed increased focus on combination lipid-lowering therapy. For patients that cannot achieve target treatment goals with statin therapy alone, the addition of the cholesterol absorption inhibitor ezetimibe leads to additional LDL-C reductions with good tolerability, and reductions in cardiovascular morbidity and mortality. The more recent Proprotein Convertase Subtilisin-Like/Kexin Type 9 (PCSK-9) inhibitors can lower LDL-C by an additional 45-65% and are also well tolerated with associated cardiovascular outcome data. These complementary approaches for LDL-C lowering in statin-treated patients lower LDL-C levels beyond that achieved with statin monotherapy. As no threshold level has been established below which LDL-C lowering benefits cease to occur, an early combination treatment strategy may lead to improved cardiovascular outcomes, particularly in high-risk patients. This review will examine the rationale, advantages and potential barriers to combination lipid-lowering therapy with reference to current guideline recommendations.

Statins plus ezetimibe in the era of proprotein convertase subtilisin/kexin type-9 inhibitors / L. De Luca, A. Corsini, M. Uguccioni, F. Colivicchi. - In: KARDIOLOGIA POLSKA. - ISSN 0022-9032. - (2020). [Epub ahead of print] [10.33963/KP.15529]

Statins plus ezetimibe in the era of proprotein convertase subtilisin/kexin type-9 inhibitors

A. Corsini
Secondo
;
2020

Abstract

Statins are first-line agents in patients with dyslipidemia, with established benefits for reducing low-density-lipoprotein cholesterol (LDL-C) levels and cardiovascular events. However, a considerable number of statin-treated patients do not achieve target LDL-C levels, even at maximally tolerated statin doses, or are intolerant to intensive statin therapy. These patients can benefit from the addition of a non-statin lipid-lowering agent, and recent cholesterol guidelines have placed increased focus on combination lipid-lowering therapy. For patients that cannot achieve target treatment goals with statin therapy alone, the addition of the cholesterol absorption inhibitor ezetimibe leads to additional LDL-C reductions with good tolerability, and reductions in cardiovascular morbidity and mortality. The more recent Proprotein Convertase Subtilisin-Like/Kexin Type 9 (PCSK-9) inhibitors can lower LDL-C by an additional 45-65% and are also well tolerated with associated cardiovascular outcome data. These complementary approaches for LDL-C lowering in statin-treated patients lower LDL-C levels beyond that achieved with statin monotherapy. As no threshold level has been established below which LDL-C lowering benefits cease to occur, an early combination treatment strategy may lead to improved cardiovascular outcomes, particularly in high-risk patients. This review will examine the rationale, advantages and potential barriers to combination lipid-lowering therapy with reference to current guideline recommendations.
Settore BIO/14 - Farmacologia
2020
24-lug-2020
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/755756
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