Treatment of dyslipidemia in the light of current guidelines ESC and III Declaration of Sopot Review article
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Published:
Jun 30, 2019
Keywords:
lipid lowering therapy, dyslipidemia, statins, fibrate, PCSK9 inhibitors, low-density lipoprotein cholesterol (LDL-C)
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Abstract
Low LDL-C concentrations is the main goal of hypercholesterolemia treatment, reducing the overall risk of cardiovascular events. In the light of the latest research on PCSK9 inhibitors and the safety of low LDL-C levels, it seems that people in the highest risk groups may benefit more from more aggressive LDL-C lowering, which was included in the 3rd Declaration of Sopot – the polish guidelines for the treatment of dyslipidemia. The first choice in pharmacotherapy are statins, which are one of the best-studied drugs used in cardiovascular prevention. If the intended therapeutic goals are not achieved, fibrates or ezetimibe should be added to the treatment. The new drug group including PCSK9 inhibitors is now mainly used in patients with familial hypercholesterolaemia and may be considered in people not tolerating standard forms of treatment.
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How to Cite
Kowalczyk , M., & Piechocki , K. (2019). Treatment of dyslipidemia in the light of current guidelines ESC and III Declaration of Sopot. Cardiology in Practice, 13(2), 15-22. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1191
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Medical evidence in cardiology
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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14. Gupta A., Thomson D., Whitehouse A. et al.: Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): A randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389(10088): 2473-2481.
15. Mach F., Ray K.K., Wiklund O. et al.: Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Eur. Heart J. 2018; 39(27): 2526-2539.
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17. Hackam D.G., Woodward M., Newby L.K. et al.: Statins and intracerebral hemorrhage: collaborative systematic review and meta-analysis. Circulation 2011; 43: 2233-2242.
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19. Stone N.J., Robinson J.G., Lichtenstein A.H. et al.: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(2): S1-S45.
20. Ahmad Z.: Statin intolerance. Am. J. Cardiol. 2014; 113: 1765-1771.
21. Lagace T.A.: PCSK9 and LDLR degradation: regulatory mechanisms in circulation and in cells. Curr. Opin. Lipidol. 2014; 25: 387-393.
22. Koren M.J., Lundqvist P., Bolognese M. et al.: Anti-PCSK9 monotherapy for hypercholesterolemia: the MENDEL-2 randomized, controlled phase III clinical trial of evolocumab. J. Am. Coll. Cardiol. 2014; 63: 2531-2540.
23. Koren M.J., Giugliano R.P., Raal F.J. et al.: Efficacy and safety of longer-term administration of evolocumab (AMG 145) in patients with hypercholesterolemia: 52-week results from the Open-Label Study of Long-Term Evaluation Against LDL-C (OSLER) randomized trial. Circulation 2014; 129: 234-243.
24. Robinson J.G., Nedergaard B.S., Rogers W.J. et al.: Effect of evolocumab or ezetimibe added to moderate or high-intensity statin therapy on LDL-C lowering in patients with hypercholesterolemia: the LAPLACE-2 randomized clinical trial. JAMA 2014; 311: 1870-1882.
25. Stroes E., Colquhoun D., Sullivan D. et al.: Anti-PCSK9 antibody effectively lowers cholesterol in patients with statin intolerance: the GAUSS-2 randomized, placebo-controlled phase 3 clinical trial of evolocumab. J. Am. Coll. Cardiol. 2014; 63: 2541-2548.
26. Blom D.J., Hala T., Bolognese M. et al.: A 52-week placebo-controlled trial of evolocumab in hyperlipidemia. N. Engl. J. Med. 2014; 370: 1809-1819.
27. Robinson J.G.: Hot line II. Coronary artery disease and lipids. Zaprezentowano na: the European Society of Cardiology Congress. 30 sierpnia – 3 września 2014. Barcelona, Hiszpania.
28. Raal F.J., Honarpour N., Blom D.J. et al.: Inhibition of PCSK9 with evolocumab in homozygous familial hypercholesterolaemia (TESLA Part B): a randomised, double-blind, placebo-controlled trial. Lancet 2014; 385: 303-392.
29. Moriarty P.M., Jacobson T.A., Bruckert E. et al.: Efficacy and safety of alirocumab, a monoclonal antibody to PCSK9, in statin-intolerant patients: design and rationale of ODYSSEY ALTERNATIVE, a randomized phase 3 trial. J. Clin. Lipidol. 2014; 8: 554-561.
30. Robinson J.G., Colhoun H.M., Bays H.E. et al.: Efficacy and safety of alirocumab as add-on therapy in high-cardiovascular-risk patients with hypercholesterolemia not adequately controlled with atorvastatin (20 or 40 mg) or rosuvastatin (10 or 20 mg): design and rationale of the ODYSSEY OPTIONS Studies. Clin. Cardiol. 2014; 37: 597-604.
2. Stroes E.S., Thompson P.D., Corsini A. et al.: European Atherosclerosis Society Consensus Panel. Statin-associated muscle symptoms: impact on statin therapy – European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur. Heart J. 2015; 36(17): 1012- 1022.
3. Catapano A.L., Graham I., De Backer G. et al.: 2016 ESC/EAS Guidelines for the management of dyslipidaemias. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur. Heart J. 2016; 37: 2999-3058.
4. Szymański F.M., Barylski M., Cybulska B. et al.: Recommendation for the management of dyslipidemia in Poland – Third Declaration of Sopot. Interdisciplinary Expert Position Statement endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy. Choroby Serca i Naczyń 2018; 15(4): 199-210.
5. Stefanick M.L., Mackey S., Sheehan M. et al.: Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N. Engl. J. Med. 1998; 339(1): 12-20.
6. Wożakowska-Kapłon B., Filipiak K.J., Mamcarz A. et al.: Actual problems of dyslipidaemia treatment in Poland – 2nd Declaration of Sopot. Experts’ Group Consensus endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy. Kardiol. Pol. 2014; 72(9): 847-853.
7. Cholesterol Treatment Trialists’ (CTT) Collaboration; Baigent C., Blackwell L., Emberson J. et al.: Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376: 1670-1681.
8. Cholesterol Treatment Trialists’ (CTT) Collaboration; Fulcher J., O’Connell R., Voysey M. et al.: Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet 2015; 385: 1397-1405.
9. Shepherd J., Blauw G.J., Murphy M.B. et al.: Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360: 1623-1630.
10. STAREE: A Clinical Trial of STAtin Therapy for Reducing Events in the Elderly (STAREE) [online: https://clinicaltrials.gov/ct2/show/NCT02099123].
11. Zhang X., Wen J., Zhang Z.: Statins use and risk of dementia: A dose-response meta analysis. Medicine (Baltimore) 2018; 97(30).
12. Kashef M.A., Giugliano G.: Legacy effect of statins: 20-year follow up of the West of Scotland Coronary Prevention Study (WOSCOPS). Glob. Cardiol. Sci. Pract. 2016; 2016(4): e201635. DOI: 10.21542/gcsp.2016.35.
13. Stroes E.S., Thompson P.D., Corsini A. et al.: Statin-associated muscle symptoms: impact on statin therapy –European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur. Heart J. 2015; 36(17): 1012-1022.
14. Gupta A., Thomson D., Whitehouse A. et al.: Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): A randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389(10088): 2473-2481.
15. Mach F., Ray K.K., Wiklund O. et al.: Adverse effects of statin therapy: perception vs. the evidence - focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract. Eur. Heart J. 2018; 39(27): 2526-2539.
16. Huisa B.N., Stemer A.B., Zivin J.A.: Atorvastatin in stroke: a review of SPARCL and subgroup analysis. Vasc. Health Risk Manag. 2010; 6: 229-236.
17. Hackam D.G., Woodward M., Newby L.K. et al.: Statins and intracerebral hemorrhage: collaborative systematic review and meta-analysis. Circulation 2011; 43: 2233-2242.
18. Keech A., Simes R.J., Barter R. et al.; The FIELD Study lnvestigators: Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366: 1849-1861.
19. Stone N.J., Robinson J.G., Lichtenstein A.H. et al.: 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129(2): S1-S45.
20. Ahmad Z.: Statin intolerance. Am. J. Cardiol. 2014; 113: 1765-1771.
21. Lagace T.A.: PCSK9 and LDLR degradation: regulatory mechanisms in circulation and in cells. Curr. Opin. Lipidol. 2014; 25: 387-393.
22. Koren M.J., Lundqvist P., Bolognese M. et al.: Anti-PCSK9 monotherapy for hypercholesterolemia: the MENDEL-2 randomized, controlled phase III clinical trial of evolocumab. J. Am. Coll. Cardiol. 2014; 63: 2531-2540.
23. Koren M.J., Giugliano R.P., Raal F.J. et al.: Efficacy and safety of longer-term administration of evolocumab (AMG 145) in patients with hypercholesterolemia: 52-week results from the Open-Label Study of Long-Term Evaluation Against LDL-C (OSLER) randomized trial. Circulation 2014; 129: 234-243.
24. Robinson J.G., Nedergaard B.S., Rogers W.J. et al.: Effect of evolocumab or ezetimibe added to moderate or high-intensity statin therapy on LDL-C lowering in patients with hypercholesterolemia: the LAPLACE-2 randomized clinical trial. JAMA 2014; 311: 1870-1882.
25. Stroes E., Colquhoun D., Sullivan D. et al.: Anti-PCSK9 antibody effectively lowers cholesterol in patients with statin intolerance: the GAUSS-2 randomized, placebo-controlled phase 3 clinical trial of evolocumab. J. Am. Coll. Cardiol. 2014; 63: 2541-2548.
26. Blom D.J., Hala T., Bolognese M. et al.: A 52-week placebo-controlled trial of evolocumab in hyperlipidemia. N. Engl. J. Med. 2014; 370: 1809-1819.
27. Robinson J.G.: Hot line II. Coronary artery disease and lipids. Zaprezentowano na: the European Society of Cardiology Congress. 30 sierpnia – 3 września 2014. Barcelona, Hiszpania.
28. Raal F.J., Honarpour N., Blom D.J. et al.: Inhibition of PCSK9 with evolocumab in homozygous familial hypercholesterolaemia (TESLA Part B): a randomised, double-blind, placebo-controlled trial. Lancet 2014; 385: 303-392.
29. Moriarty P.M., Jacobson T.A., Bruckert E. et al.: Efficacy and safety of alirocumab, a monoclonal antibody to PCSK9, in statin-intolerant patients: design and rationale of ODYSSEY ALTERNATIVE, a randomized phase 3 trial. J. Clin. Lipidol. 2014; 8: 554-561.
30. Robinson J.G., Colhoun H.M., Bays H.E. et al.: Efficacy and safety of alirocumab as add-on therapy in high-cardiovascular-risk patients with hypercholesterolemia not adequately controlled with atorvastatin (20 or 40 mg) or rosuvastatin (10 or 20 mg): design and rationale of the ODYSSEY OPTIONS Studies. Clin. Cardiol. 2014; 37: 597-604.