Current Treatment of Dyslipidemia: A New Paradigm for Statin Drug Use and the Need for Additional Therapies

Abstract

Coronary heart disease (CHD) is the leading cause of death in most countries, with the high prevalence currently driven by dual epidemics of obesity and diabetes. Statin drugs, the most effective, evidence-based agents to prevent and treat this disease, have a central role in management and are advised in all published guidelines. The 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol and assessment guidelines ('new ACC/AHA guidelines') emphasized global cardiovascular (CV) risk reduction as opposed to targeting low-density lipoprotein-cholesterol (LDL-C) levels, stressed the use of statins in two dose intensities, utilized a new risk calculator using pooled cohort equations, and lowered the risk cutoff for initiation of statin therapy. Although there were major strengths of the new ACC/AHA guidelines, substantial controversy followed their release, particulars of which are discussed in this review. They were generally regarded as improvements in an ongoing transition using evidenced-based data for maximum patient benefit. Several guidelines, other than the ACC/AHA guidelines, currently provide practitioners with choices, some depending on practice locations. Cholesterol control with statin drugs is used in all paradigms. However, some patients respond inadequately, approximately 15% are intolerant, and other factors prevent attaining cholesterol goals in as many as 40% of patients. Even after treatment, substantial residual risk for ongoing major events remains. Another readily available modality that can rival statin drugs in effectiveness is vast improvement in diet and lifestyle within the general population; however, despite great effort, existing programs to implement such changes have failed. Hence, despite unrivaled success, there is great need for additional drugs to prevent and treat CHD, whether as monotherapy or in combination with statin drugs. New American guidelines do not discuss or recommend any nonstatin drugs for CHD, and the US FDA has moved away from approving drugs based solely on changes in surrogates in the absence of clinical outcomes trials. Both have significantly altered the realities of developing pharmacotherapies and cardiology practice.

n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: Principles, Practices, Pitfalls, and Promises - A Contemporary Review

“…Morbidity and mortality from this disease, particularly coronary heart disease (CHD), is unacceptably high in every country, and even when state-of-the-art treatment is achieved, deadly events continue [1][2][3]. Additional data are also valuable for public health policymakers, since consumption of these agents is popular among 8% of the American population, and the global omega-3 market amounts to USD 31.4 billion (KWD 9,460,820,000.00), as questions swirl about the wisdom of this practice [4].…”

Assessment of lipid profile when using lipid-lowering therapy (statins) in patients with coronary atherosclerosis

“…Лечение статинами рассматривается как один из наи-более эффективных методов для улучшения результа-тов лечения у пациентов с коронарным атеросклерозом [7], и занимает ведущее место в Рекомендациях по лече-нию дислипидемий [12]. Интенсивная липид-сни-жающая терапия сопровождается снижением уровня ХС атерогенных липопротеинов и риска ССЗ в большей сте-пени, чем это достигается на фоне терапии умеренны-ми или низкими дозами статинов [13].…”

Current Treatment of Dyslipidemia: Evolving Roles of Non-Statin and Newer Drugs

“…Changes in statin (HMG-CoA reductase inhibitor) allocation according to a new risk calculator included in the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol and assessment guidelines (referred to as the new ACC/AHA guidelines), the elimination of low-density lipoprotein cholesterol (LDL-C) targets, and a lower threshold for the initiation of statin therapy based upon total cardiovascular (CV) risk are discussed elsewhere [1]. However, at the same time, limitations in the use of statin drugs have received more attention, particularly in view of the greater proportion of the population receiving these drugs.…”