#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

The importance of nonstatin therapies for LDL-cholesterol lowering in the management of very high and high atherosclerotic cardiovascular risk


Authors: Daniel Pella
Authors‘ workplace: II. kardiologická klinika LF UPJŠ a Východoslovenský ústav srdcovocievnych chorôb, a. s., Košice
Published in: AtheroRev 2023; 8(2): 77-83
Category: Reviews

Overview

The role of LDL-cholesterol (LDL-C) in the pathogenesis of atherosclerosis and in the subsequent increase in the risk of atherosclerotic cardiovascular disease (ACVD) is unquestionable. The only subject of expert debate is how significantly and in what way this level needs to be reduced. However, there is also general agreement that this should be conditional on the level of cardiovascular (CV) risk of the individual. This is where opinions start to diverge – who are the patients with the highest CV risk, and who, conversely, are those who pharmacologically just need to be treated less intensively? Differences also exist in opinions about how early to start treatment, how long to continue it, and in what manner. In most cases, the recommendations of professional societies are based on Evidence Based Medicine (EBM), which stratifies individual candidates for treatment according to the level of evidence and classes of recommendations. Nevertheless, there are many situations in clinical practice in which management may not be completely specified in the recommendations. The aim of this review is to help improve the situation in the secondary prevention of atherosclerosis by highlighting the role of non-statin drugs and the potential for their use in light of the benefits demonstrated to date and the limitations of their use.

Keywords:

hypercholesterolemia – hypolipidemic drugs – LDL-cholesterol – non-statin drugs


Sources

1. Piepoli MF, Hoes AW, Agewall S et al. [Task Force Members; Additional Contributor]. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37(29): 2315–2381. Dostupné z DOI: <http://dx.doi.org/10.1093/ eurheartj/ehw106>.

2. Bytyçi I, Penson PE, Mikhailidis DP et al. Prevalence of statin intolerance: a meta-analysis. Eur Heart J 2022; 43(34): 3213–3223. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehac015>.

3. [Task Force Members; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies]. 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis 2019; 290: 140–205. Dostupné z DOI: <http://dx.doi.org/ 10.1016/j.atherosclerosis.2019.08.014>.

4. Visseren FL, Mach F, Smulders YM et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42(34): 3227–3337. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ ehab484>.

5. LLoyd-Jones DM, Morris PB, Ballantyne CM et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL- -cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80(14): 1366–1418. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2022.07.006>.

6. Banach M, Penson PE, Vrablik M et al. Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP). Pharmacol Res 2021; 166: 105499. Dostupné z DOI: <http://dx.doi.org/10.1016/j.phrs.2021.105499>.

7. Tokgozoglu L, Torp-Pedersen C. Redefining cardiovascular risk prediction: is the crystal ball clearer now? Eur Heart J 2021; 42(25): 2468–2471. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehab310>.

8. Pella D, Tóth Š, Paralič J et al. The possible role of machine learning in detection of increased cardiovascular risk patients – KSC MR Study (design). Arch Med Sci 2020; 18(4): 991–997. Dostupné z DOI: <http:// dx.doi.org/10.5114/aoms.2020.99156>.

9. Arnett DK, Blumenthal RS, Albert MA et al. 2019 ACC/AHA guideline on primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74(10): e177–e232. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2019.03.010>.

10. European Commission. EU register of Health Claims. Dostuoné z WWW: <https://ec.europa.eu/food/food-feed-portal/screen/health-claims/ eu-register>. Food and Feed Information Portal. Entry ID: 1648, 1700. [01–06–2022]

11. Wood FA, Howard JP, Finegold JA et al. N-of-1 trial of a statin, placebo, or no treatment to assess side effects. N Engl J Med 2020; 383(22): 2182– 2184. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMc2031173>.

12. Gupta A, Thompson 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 (ASCOTLLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase. Lancet 2017; 389(10088): 2473–2481. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(17)31075–9>.

13. US Food & Drug Administration. Drugs@FDA – Zetia (ezetimibe). Dostupné z WWW: <https://www.accessdata.fda.gov/scripts/cder/daf/ index.cfm?eventĽBasicSearch.process>. [10–12–2021]

14. Cannon CP, Blazing MA, Giugliano RP et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372(25): 2387– 2397. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1410489>.

15. Baigent C, Landray MJ, Reith C et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011; 377(9784): 2181–2192. Dostupné z DOI: <http:// dx.doi.org/10.1016/S0140–6736(11)60739–3>.

16. US Food & Drug Administration. Drugs@FDA – Praluent (Alirocumab). Dostupné z WWW: <https://www.accessdata.fda.gov/scripts/cder/daf/ index.cfm?event¼BasicSearch.process>. [10–12–2021]

17. US Food & Drug Administration. Drugs@FDA – Repatha (Evolocumab). Dostupné z WWW: <https://www.accessdata.fda.gov/scripts/cder/daf/ index.cfm?event¼BasicSearch.process>. [10–12–2021]

18. Schwartz GG, Steg PG, Szarek M et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 2018; 379(22): 2097– 2107. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1801174>.

19. Sabatine MS, Giugliano RP, Keech AC et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376(18): 1713–1722. Dostupné z DOI: <http://dx.doi.org/10.1056/ NEJMoa1615664>.

20. US Food & Drug Administration. Drugs@FDA -Nexletol (bempedoic acid). Dostupné z WWW: <https://www.accessdata.fda.gov/scripts/cder/ daf/index.cfm?event¼overview.process&ApplNo¼211616>. [10–12–2021]

21. US Food & Drug Administration. Drugs@FDA -Nexlizet (bempedoic acid; ezetimibe). Dostupné z WWW: <https://www.accessdata.fda.gov/ scripts/cder/daf/index.cfm?event¼overview.process&ApplNo¼211617>. [10–12–2021]

22. Nissen SE, Lincoff AM, Brennan D et al. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med 2023; 388(15): 1353–1364. Dostupné z DOI: <http://dx.doi.org/10.1056/ NEJMoa2215024>.

23. Raal FJ, Kallend D, Ray KK et al. Inclisiran for the treatment of heterozygous familial hypercholesterolemia. N Engl J Med 2020; 382(16): 1520– 1530. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1913805>.

24. Ray KK, Landmesser U, Leiter LA et al. Inclisiran in patients at high cardiovascular risk with elevated LDL cholesterol. N Engl J Med 2017; 376 (15): 1430–1440. Dostupné z DOI: <http://dx.doi.org/10.1056/ NEJMoa1615758>.

25. LEQVIO (inclisiran) [package insert]. Dostupné z WWW: <https://www. novartis.us/sites/ www.novartis.us/files/leqvio.pdf>. [28–01–2022]

26. Laufs U, Parhofer KG, Ginsberg HN et al. Clinical review on triglycerides. Eur Heart J 2020; 41(1): 99–109c. Dostupné z DOI: <http://dx.doi. org/10.1093/eurheartj/ehz785>.

27. Raal FJ, Rosenson RS, Reeskamp LF et al. Evinacumab for homozygous familial hypercholesterolemia. N Engl J Med 2020; 383(8): 711–720. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa2004215>.

28. EVKEEZA (evinacumab-dgnb) [package insert]. Dostupné z WWW: <https://www.regeneron.com/downloads/evkeeza_pi.pdf.Accessed>. [20–01–2022]

29. US Food & Drug Administration. Drugs@FDA -Juxtapid (lomitapide). Dostupné z WWW: <https://www.accessdata.fda.gov/scripts/cder/daf/ index.cfm?eventĽBasicSearch.process>. [10-12-2021]

Labels
Angiology Diabetology Internal medicine Cardiology General practitioner for adults

Article was published in

Athero Review

Issue 2

2023 Issue 2

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#