ESC/EAS Guidelines for the management of dyslipidaemias

Catapano, Alberico L.; Reiner, Željko; Backer, Guy De; Graham, Ian; Taskinen, Marja‐Riitta; Wiklund, Olov; Agewall, Stefan; Alegría, Eduardo; Chapman, M. John; Durrington, Paul N.; Erdine, Serap; Halcox, Julian; Hobbs, FD Richard; Kjekshus, John; Filardi, Pasquale Perrone; Riccardi, Gabriele; Storey, Robert F.; Wood, David

doi:10.1016/j.atherosclerosis.2011.06.028

Cited by 565 publications

(203 citation statements)

References 318 publications

(220 reference statements)

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“…To assess the response to lipid‐lowering therapy, LDL‐P targets have been proposed, based on population equivalent levels for LDL‐C targets (<20th percentile for high‐ and very high‐risk patients). It should be noted that while treatment targets for LDL‐C, non–HDL‐C, and apoB have been recommended in various national dyslipidemia guidelines, LDL‐P targets have not been endorsed 1, 7, 12, 15. Achievement of LDL‐P targets that are equivalent to LDL‐C and non–HDL‐C targets based on population percentiles have been shown to require intensive therapy 44.…”

Section: Discussionmentioning

confidence: 99%

“…Statin therapy is the recommended first‐line therapeutic approach for lipid management of high‐risk patients; however, many patients with diabetic dyslipidemia do not achieve adequate low‐density lipoprotein (LDL) cholesterol (LDL‐C) lowering on statin monotherapy 7, 8, 9, 10, 11. This residual risk may be attributed in part to atherogenic dyslipidemia, characterized by high levels of triglycerides, low levels of high‐density lipoprotein (HDL) cholesterol (HDL‐C), and high LDL‐particle (LDL‐P) numbers in these patients 1.…”

Section: Introductionmentioning

confidence: 99%

“…This residual risk may be attributed in part to atherogenic dyslipidemia, characterized by high levels of triglycerides, low levels of high‐density lipoprotein (HDL) cholesterol (HDL‐C), and high LDL‐particle (LDL‐P) numbers in these patients 1. In addition to LDL‐C lowering, non–HDL‐C and apolipoprotein B (apoB) have been recommended as treatment targets for assessment of individuals with diabetic dyslipidemia 1, 7, 12, 13, 14, 15…”

Section: Introductionmentioning

confidence: 99%

“…Several international guidelines endorse statin uptitration, switching to a more‐potent statin therapy, and/or combination therapy for high‐risk individuals in need of additional cholesterol lowering 7, 12, 13, 14, 15. US guidelines recommend using the maximum tolerated statin dose with consideration given to the addition of a nonstatin cholesterol‐lowering drug if the clinical benefit outweighs the safety risk in these patients 16.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Tomassini

Tershakovec

et al. 2015

JAHA

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BackgroundPatients with diabetes mellitus and cardiovascular disease may not achieve adequate low‐density lipoprotein cholesterol (LDL‐C) lowering on statin monotherapy, attributed partly to atherogenic dyslipidemia. More intensive LDL‐C–lowering therapy can be considered for these patients. A previous randomized, controlled study demonstrated greater LDL‐C lowering in diabetic patients with symptomatic cardiovascular disease who switched from simvastatin 20 mg (S20) or atorvastatin 10 mg (A10) to combination ezetimibe/simvastatin 10/20 mg (ES10/20) therapy, compared with statin dose‐doubling (to S40 or A20) or switching to rosuvastatin 10 mg (R10). The effect of these regimens on novel biomarkers of atherogenic dyslipidemia (low‐ and high‐density lipoprotein particle number and lipoprotein‐associated phospholipase A2 [Lp‐PLA2]) was assessed.Methods and ResultsTreatment effects on low‐ and high‐density lipoprotein particle number (by NMR) and Lp‐PLA2 (by ELISA) were evaluated using plasma samples available from 358 subjects in the study. Switching to ES10/20 reduced low‐density lipoprotein‐particle number numerically more than did statin dose‐doubling and was comparable with R10 (−133.3, −94.4, and −56.3 nmol/L, respectively; P>0.05). Increases in high‐density lipoprotein particle number were significantly greater with switches to ES10/20 versus statin dose‐doubling (1.5 and −0.5 μmol/L; P<0.05) and comparable with R10 (0.7 μmol/L; P>0.05). Percentages of patients attaining low‐density lipoprotein particle number levels <990 nmol/L were 62.4% for ES10/20, 54.1% for statin dose‐doubling, and 57.0% for R10. Switching to ES10/20 reduced Lp‐PLA2 activity significantly more than did statin dose‐doubling (−28.0 versus −3.8 nmol/min per mL, P<0.05) and was comparable with R10 (−28.0 versus −18.6 nmol/min per mL; P>0.05); effects on Lp‐PLA2 concentration were modest.ConclusionsIn diabetic patients with dyslipidemia, switching from statins to combination ES10/20 therapy generally improved lipoprotein subclass profile and Lp‐PLA2 activity more than did statin dose‐doubling and was comparable with R10, consistent with its lipid effects.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00862251.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Tomassini

Tershakovec

et al. 2015

JAHA

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“…The reduction in low‐density lipoprotein cholesterol (LDL‐C) levels with statins has been shown to be highly effective for reducing CV risk in a wide range of patient populations,5, 6 including Asian patients 7, 8, 9, 10. Recent dyslipidemia treatment guidelines have emphasized the importance of LDL‐C lowering with statins for the prevention of CVD,11, 12 including high‐intensity statin therapy to achieve ≥50% reduction in LDL‐C 12. Despite this overwhelming evidence to support lipid lowering through the use of statins to reduce CV risk, dyslipidemia is often undertreated in Asian populations, with reports of up to 60% of high‐risk patients not receiving a statin,13, 14 and low rates of goal attainment in those patients receiving lipid‐lowering treatment (~50%), most notably in those at very high CV risk (~30%) 15, 16…”

Section: Introductionmentioning

confidence: 99%

Safety of atorvastatin in Asian patients within clinical trials

Chan

Kong

Bao

et al. 2016

Cardiovascular Therapeutics

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SummaryIntroductionData on statin safety in Asian patients are limited compared with evidence from Western populations.AimThis study assessed atorvastatin safety among Asian patients enrolled in 58 randomized clinical trials.MethodsData from 52 short‐term trials (median exposure 4–72 weeks) and six long‐term cardiovascular outcomes trials (median exposure 3.1–4.9 years) conducted across the atorvastatin 10–80‐mg dose range were analyzed retrospectively to assess the incidence of safety endpoints.ResultsA total of 77 952 patients were identified (49 974 received atorvastatin), among whom 3191 were Asian (2519 received atorvastatin). In the short‐term trials, the incidence of all‐causality adverse events (AEs) and serious AEs (SAEs) in Asian patients treated with atorvastatin was similar to or lower than that observed with other statins or placebo, and discontinuations due to treatment‐related AEs/SAEs were infrequent (2.0% across all doses). These observations were confirmed in the long‐term trials. Treatment‐related SAEs were rare (n = 4) among Asian patients receiving atorvastatin. No cases of rhabdomyolysis were observed in atorvastatin‐treated Asian patients, and the incidence of myalgia was 1.8% in the short‐term studies and 6.7% in the long‐term trials. Elevations (>3× the upper limit of normal) in liver transaminases were observed in ~2% of Asian patients receiving atorvastatin; renal AEs occurred in <2%.ConclusionThe incidence of AEs/SAEs with atorvastatin 10–40‐mg in patients of Asian origin was low and comparable to placebo. Further evaluation of atorvastatin 80‐mg is required owing to the limited number of Asian patients (n = 281; 11.2%) who received this dose.

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