Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force

Abstract

Background and aims: This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in highrisk and very-high-risk patients. Methods: Evidence-based review. Results: Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro-and microvascular benefits in patients with type 2 diabetes mellitus. Conclusions: This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.

Dyslipidemia Management in Patients with Coronary Artery Disease. Data from the POLASPIRE Survey

“…Indeed, one critically important issue of the lack of efficacy of the lipid-lowering therapy is the very low application of combination therapy. Considering the new recommendations, immediate application of the combination therapy with statin and ezetimibe, and even triple therapy in selected cases, especially for the very-high-risk patients, might significantly improve effectiveness of the lipid-lowering treatment [5,29,30].…”

EAS Task Force gives practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients

“…Clinicians need information on how best to implement these guideline recommendations in their routine practice. This new statement from an EAS Task Force provides practical guidance to improve LDL-C goal attainment aided by accessible algorithms [9].…”

The treatment of heterozygous familial hypercholesterolemia — a local perspective

“…One of the most important actions in the treatment of hypercholesterolaemia (regardless of the genetic background) is to establish a treatment goal for our patient. A detailed description of the process is provided by the EAS/ESC guidelines [6]. Briefly, a patient with CVD should be treated intensely to achieve LDL-C level below 55 mg% (in some cases even below 40 mg%).…”

“…alirocumab and evolocumab). They are extremely effective as LDL-C lowering drugs (up to 85% as a part of combined therapy), which is accompanied by improvements in cardiovascular outcomes [6]. The major disadvantage of those therapies is their high cost (around 2000 PLN per month).…”