Emergency Institute for Cardiovascular Diseases "C.C. Iliescu", Bucharest, Romania.
Department of Diabetes, Nutrition and Metabolic Diseases, Faculty of General Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Lipids Health Dis. 2020 May 6;19(1):85. doi: 10.1186/s12944-020-01275-x.
In the last 50 years, several clinical and epidemiological studies during have shown that increased levels of low-density lipoprotein cholesterol (LDLc) are associated with the development and progression of atherosclerotic lesions. The discovery of β-Hydroxy β-methylglutaryl-CoA reductase inhibitors (statins), that possess LDLc-lowering effects, lead to a true revolution in the prevention and treatment of cardiovascular diseases. Statins remain the cornerstone of LDLc-lowering therapy. Lipid-lowering drugs, such as ezetimibe and bile acid sequestrants, are prescribed either in combination with statins or in monotherapy (in the setting of statin intolerance or contraindications to statins). Microsomal triglyceride transfer protein inhibitors and protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are other drug classes which have been investigated for their potential to decrease LDLc. PCSK9 have been approved for the treatment of hypercholesterolemia and for the secondary prevention of cardiovascular events. The present narrative review discusses the latest (2019) guidelines of the European Atherosclerosis Society/European Society of Cardiology for the management of dyslipidemia, focusing on LDLc-lowering drugs that are either already available on the market or under development. We also consider "whom, when and how" do we treat in terms of LDLc reduction in the daily clinical practice.
在过去的 50 年中，有几项临床和流行病学研究表明，低密度脂蛋白胆固醇（LDLc）水平升高与动脉粥样硬化病变的发生和进展有关。β-羟-β-甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）的发现具有降低 LDLc 的作用，这真正推动了心血管疾病的预防和治疗的变革。他汀类药物仍然是降低 LDLc 治疗的基石。降脂药物，如依折麦布和胆汁酸螯合剂，要么与他汀类药物联合使用，要么单独使用（在他汀类药物不耐受或对他汀类药物有禁忌的情况下）。微粒体甘油三酯转移蛋白抑制剂和前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂是另外两类被研究用于降低 LDLc 的药物。PCSK9 已被批准用于治疗高胆固醇血症和心血管事件的二级预防。本综述讨论了欧洲动脉粥样硬化学会/欧洲心脏病学会关于血脂异常管理的最新（2019 年）指南，重点介绍了已上市或正在开发中的降低 LDLc 的药物。我们还考虑了在日常临床实践中，从“何人、何时以及如何”的角度来考虑 LDLc 的降低。
