Statins in certain patient populations: scientific evidence and algorithms for practicing physicians

Abstract

Treatment with 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors (statins) is the basis for primary and secondary prevention of atherosclerosis and is regulated by many international and Russian guidelines and consensus. Data from lipid-lowering studies with "hard" endpoints showed that combination therapy can also lead to a further reduction in cardiovascular (CV) risk with the achievement of very low levels of low-density lipoprotein cholesterol (0.5–1 mmol/L) without increasing the risk of side effects. Despite the scientific progress in this field, there are large barriers between the recommendations and the real clinical practice of using statins in our country. As before, even patients with a very high CV risk are prescribed low and medium doses of statins by doctors of various specialties; the possibilities of combination therapy are still poorly realized. This review will provide an analysis of the evidence base, as well as an attempt to harmonize recommendations, expert consensus on optimizing statin therapy in certain patient groups – in primary prevention (low/moderate CV risk), in patients with high/very high CV risk in patients with arterial hypertension and dyslipidemia, as well as in patients with confirmed familial hypercholesterolemia. This publication presents possible algorithms for the use of statins in these categories of patients, which, in the author's opinion, will be useful for practicing physicians in their day-to-day clinical practice. Keywords: low-density lipoprotein cholesterol, dyslipidemia, statins, algorithms, primary prevention, arterial hypertension, cardiovascular risk, familial hypercholesterolemia For citation: Susekov AV. Statins in certain patient populations: scientific evidence and algorithms for practicing physicians. Consilium Medicum. 2021; 23 (1): 52–60. DOI: 10.26442/20751753.2021.1.200626