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

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TitrePractical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force
Type de publicationJournal Article
Year of Publication2021
AuteursAverna M, Banach M, Bruckert E, Drexel H, Farnier M, Gaita D, Magni P, Maerz W, Masana L, Silva AMello e, Reiner Z, Ros E, Vrablik M, Zambon A, Zamorano JL, Stock JK, Tokgozoglu LS, Catapano AL
JournalATHEROSCLEROSIS
Volume325
Pagination99-109
Date PublishedMAY
Type of ArticleArticle
ISSN0021-9150
Mots-clés2019 ESC, Combination treatment, EAS Dyslipidaemia Guidelines, High-risk, LDL cholesterol, Lipid goals, Triglycerides
Résumé

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.

DOI10.1016/j.atherosclerosis.2021.03.039