Second Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.
Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), Pond Street, London, NW3 2QG, UK.
Hormones (Athens). 2018 Dec;17(4):461-478. doi: 10.1007/s42000-018-0058-9. Epub 2018 Sep 18.
The past decade has witnessed considerable progress in the field of lipids. New drugs have been "rapidly" developed and some of these drugs have already been evaluated in event-based large trials. This evidence has led to the guidelines recommending new, more aggressive treatment goals for low-density lipoprotein cholesterol (LDL-C) levels. Although LDL-C remains the principal goal for cardiovascular disease (CVD) risk reduction, there has also been considerable interest in other lipid variables, such as high-density lipoprotein cholesterol, triglycerides, and lipoprotein(a). Statin intolerance is now considered a very important topic in daily clinical practice. This has resulted in more attention focusing on non-statin drugs [e.g., ezetimibe and proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors] and statin-related side effects. The latter mainly involve muscles, but there is also a need to consider other adverse effects associated with statin use (e.g., new onset diabetes). New specific areas of statin use have attracted interest. For example, statin-loading before procedures (e.g., coronary stenting), the prevention of stroke, and the treatment of non-alcoholic fatty liver disease (NAFLD). Statins will remain the most widely used drugs to treat dyslipidaemia and decrease CVD risk. However, we also need to briefly consider some other lipid-lowering drugs, including those that may become available in the future.
过去十年，脂质领域取得了相当大的进展。新型药物“迅速”研发成功，其中一些药物已经在基于事件的大型试验中进行了评估。这些证据促使指南建议采用新的、更积极的治疗目标，以降低低密度脂蛋白胆固醇（LDL-C）水平。尽管 LDL-C 仍然是降低心血管疾病（CVD）风险的主要目标，但人们对其他脂质变量（如高密度脂蛋白胆固醇、甘油三酯和脂蛋白（a））也产生了浓厚的兴趣。他汀类药物不耐受现在被认为是日常临床实践中的一个非常重要的话题。这导致人们更加关注非他汀类药物[例如，依折麦布和前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂]和他汀类药物相关的副作用。后者主要涉及肌肉，但也需要考虑与他汀类药物使用相关的其他不良反应（例如新发糖尿病）。他汀类药物使用的新特定领域引起了人们的兴趣。例如，在介入治疗（如冠状动脉支架置入术）前进行他汀类药物负荷治疗、预防中风以及治疗非酒精性脂肪性肝病（NAFLD）。他汀类药物仍将是治疗血脂异常和降低 CVD 风险最广泛使用的药物。然而，我们还需要简要考虑其他一些降脂药物，包括未来可能上市的药物。
