Znaczenie preparatów łączonych w leczeniu zaburzeń lipidowych oraz w prewencji zdarzeń sercowo-naczyniowych Artykuł przeglądowy
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Opublikowane:
cze 30, 2025
Słowa kluczowe:
dyslipidemia, hipercholesterolemia, LDL-cholesterol, łączone preparaty, preparaty SPC
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Abstrakt
Choroby sercowo-naczyniowe są najczęstszą przyczyną zgonów w Polsce i na świecie. Zaburzenia lipidowe stanowią najczęstszy odwracalny czynnik ich ryzyka. Podstawowym elementem leczenia pozostają silnie działające statyny w maksymalnych tolerowanych dawkach, ezetymib oraz inhibitory PCSK-9. Wprowadzenie łączonych preparatów zawierających statyny z ezetymibem pozwoliło na zwiększenie adherencji. Dodatkowo leczenie takie wiąże się z silniejszym o ok. 15% efektem obniżenia stężenia LDL-cholesterolu w porównaniu z pojedynczymi tabletkami. Inicjacja leczenia łączonym preparatem w pojedynczej tabletce została wymieniona w wytycznych Europejskiego Towarzystwa Kardiologicznego dot. leczenia pacjentów po ostrych zespołach wieńcowych (II B). Jednakże w nawiązaniu do wyników badań pokazujących, że im szybciej i im bardziej obniżymy stężenie LDL-cholesterolu, tym lepsze rokowanie będą mieli nasi pacjenci, zasadne wydaje się rozważenie takiego leczenia w uzasadnionych przypadkach (zwłaszcza u pacjentów wysokiego i bardzo wysokiego ryzyka z wyjściowym stężeniem LDL-cholesterolu powyżej 120 mg/dl).
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Jak cytować
Muszyński, P., & Tomaszuk-Kazberuk, A. (2025). Znaczenie preparatów łączonych w leczeniu zaburzeń lipidowych oraz w prewencji zdarzeń sercowo-naczyniowych. Medycyna Faktów , 18(2(67), 190-195. https://doi.org/10.24292/01.MF.0225.04
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Bibliografia
1. Visseren FLJ, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Eur Heart J. 2021; 42(34): 3227-337.
2. Jankowski P, Topór-Mądry R, Gąsior M et al. Management and predictors of clinical events in 75 686 patients with acute myocardial infarction. Polish Heart Journal (Kardiologia Polska). 2022; 80(4): 468-75.
3. Banach M, Burchardt P, Chlebus K et al. Wytyczne PTL/KLRwP/PTK/ PTDL/PTD/PTNT diagnostyki i leczenia zaburzeń lipidowych w Polsce 2021. Lekarz POZ Suplement. 2021.
4. Ross E, Shah N, Leeper N. Statin Intensity or Achieved LDL? Practice-based Evidence for the Evaluation of New Cholesterol Treatment Guidelines. PloS One. 2016; 11: e0154952.
5. Katzmann JL, Sorio-Vilela F, Dornstauder E et al. Non-statin lipid-lowering therapy over time in very-high-risk patients: effectiveness of fixe-dose statin/ezetimibe compared to separate pill combination on LDL-C. Clin Res Cardiol. 2022; 111(3) 243-52.
6. Banach M, Surma S, Toth PP. 2023: The year in cardiovascular disease – the year of new and prospective lipid lowering therapies. Can we render dyslipidemia a rare disease by 2024? Arch Med Sci. 2023; 19(6): 1602-15.
7. Kim B-K, Hong S-J, Lee Y-J et al. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. The Lancet. 2022; 400(10349): 380-90.
8. Lee S-J, Joo JH, Park S et al. Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol. 2023; 82(5): 401-10.
9. Lee SA, Hong SJ, Sung JH et al. Effectiveness of low-intensity atorvastatin 5 mg and ezetimibe 10 mg combination therapy compared with moderate-intensity atorvastatin 10 mg monotherapy: A randomized, double-blinded, multi-center, phase III study. Medicine (Baltimore). 2023; 102(47): e36122.
10. Otsuki H, Arashi H, Yamaguchi J et al. Effect of Ezetimibe + Pitavastatin on Cardiovascular Outcomes in Patients with ST-Segment Elevation Myocardial Infarction (from the HIJ-PROPER Study). Am J Cardiol. 2020; 132: 15-21.
11. Oyama K, Giugliano RP, Blazing MA et al. Baseline Low-Density Lipoprotein Cholesterol and Clinical Outcomes of Combining Ezetimibe With Statin Therapy in IMPROVE-IT. J Am Coll Cardiol. 2021; 78(15): 1499-507.
12. Farnier M, Santos RD, Cosin-Sales J et al. Projected impact of treatment intensification with statin, ezetimibe, and statin plus ezetimibe fixe-dose combination on MACE across six countries. Eur J Prev Cardiol. 2022; 29(17): 2264-71.
13. Tsujita K, Sugiyama S, Sumida H et al. Impact of Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention: The Multicenter Randomized Controlled PRECISE-IVUS Trial. J Am Coll Cardiol. 2015; 66(5): 495-507.
14. Byrne RA, Rossello X, Coughlan JJ et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023; 44(38): 3720-826.
15. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
16. Perez de Isla L, Liberopoulos E, Dovizio M et al. Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy. Adv Ther. 2024; 41(8): 3407-18.
17. Rea F, Savaré L, Corrao G et al. Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe. Adv Ther. 2021; 38(10): 5270-85.
18. Ray KK, Reeskamp LF, Laufs U et al. Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2021; 43(8): 830-3.
19. Banach M, Reiner Ž, Surma S et al. 2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP). Drugs. 2024; 84(12): 1541-77.
2. Jankowski P, Topór-Mądry R, Gąsior M et al. Management and predictors of clinical events in 75 686 patients with acute myocardial infarction. Polish Heart Journal (Kardiologia Polska). 2022; 80(4): 468-75.
3. Banach M, Burchardt P, Chlebus K et al. Wytyczne PTL/KLRwP/PTK/ PTDL/PTD/PTNT diagnostyki i leczenia zaburzeń lipidowych w Polsce 2021. Lekarz POZ Suplement. 2021.
4. Ross E, Shah N, Leeper N. Statin Intensity or Achieved LDL? Practice-based Evidence for the Evaluation of New Cholesterol Treatment Guidelines. PloS One. 2016; 11: e0154952.
5. Katzmann JL, Sorio-Vilela F, Dornstauder E et al. Non-statin lipid-lowering therapy over time in very-high-risk patients: effectiveness of fixe-dose statin/ezetimibe compared to separate pill combination on LDL-C. Clin Res Cardiol. 2022; 111(3) 243-52.
6. Banach M, Surma S, Toth PP. 2023: The year in cardiovascular disease – the year of new and prospective lipid lowering therapies. Can we render dyslipidemia a rare disease by 2024? Arch Med Sci. 2023; 19(6): 1602-15.
7. Kim B-K, Hong S-J, Lee Y-J et al. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. The Lancet. 2022; 400(10349): 380-90.
8. Lee S-J, Joo JH, Park S et al. Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol. 2023; 82(5): 401-10.
9. Lee SA, Hong SJ, Sung JH et al. Effectiveness of low-intensity atorvastatin 5 mg and ezetimibe 10 mg combination therapy compared with moderate-intensity atorvastatin 10 mg monotherapy: A randomized, double-blinded, multi-center, phase III study. Medicine (Baltimore). 2023; 102(47): e36122.
10. Otsuki H, Arashi H, Yamaguchi J et al. Effect of Ezetimibe + Pitavastatin on Cardiovascular Outcomes in Patients with ST-Segment Elevation Myocardial Infarction (from the HIJ-PROPER Study). Am J Cardiol. 2020; 132: 15-21.
11. Oyama K, Giugliano RP, Blazing MA et al. Baseline Low-Density Lipoprotein Cholesterol and Clinical Outcomes of Combining Ezetimibe With Statin Therapy in IMPROVE-IT. J Am Coll Cardiol. 2021; 78(15): 1499-507.
12. Farnier M, Santos RD, Cosin-Sales J et al. Projected impact of treatment intensification with statin, ezetimibe, and statin plus ezetimibe fixe-dose combination on MACE across six countries. Eur J Prev Cardiol. 2022; 29(17): 2264-71.
13. Tsujita K, Sugiyama S, Sumida H et al. Impact of Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention: The Multicenter Randomized Controlled PRECISE-IVUS Trial. J Am Coll Cardiol. 2015; 66(5): 495-507.
14. Byrne RA, Rossello X, Coughlan JJ et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J. 2023; 44(38): 3720-826.
15. Vrints C, Andreotti F, Koskinas KC et al. 2024 ESC Guidelines for the management of chronic coronary syndromes: Developed by the task force for the management of chronic coronary syndromes of the European Society of Cardiology (ESC) Endorsed by the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024; 45(36): 3415-537.
16. Perez de Isla L, Liberopoulos E, Dovizio M et al. Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy. Adv Ther. 2024; 41(8): 3407-18.
17. Rea F, Savaré L, Corrao G et al. Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe. Adv Ther. 2021; 38(10): 5270-85.
18. Ray KK, Reeskamp LF, Laufs U et al. Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2021; 43(8): 830-3.
19. Banach M, Reiner Ž, Surma S et al. 2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP). Drugs. 2024; 84(12): 1541-77.