Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Largo Egidio Meneghetti 2, 35131, Padova, Italy.
Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
Curr Atheroscler Rep. 2020 Jun 3;22(7):26. doi: 10.1007/s11883-020-00844-w.
Statins represent the cornerstone for the treatment of hypercholesterolemia, although muscle-related side effects and dysregulation of glucose metabolism have strongly limited their adherence and compliance especially in primary prevention therapy. The purpose of the present review is to provide the most recent evidence of the efficacy and safety of statins in monotherapy or combination with new lipid-lowering drugs.
Recent "life-long" analysis conducted on young familial hypercholesterolemia patients, elderly hypocholesterolemic subjects, and from a 20-year follow-up of randomized controlled trial (RCT) have been published confirming that the cardiovascular benefits of statin therapy, in patients for whom it is recommended by current guidelines, greatly outweigh the risks of side effects. In addition, recent therapies to be used in combination with statins have shown to increase the percentage of patients at goal for low-density lipoprotein - cholesterol (LDL-C) with a good safety profile. The cardiovascular (CV) benefits of monoclonal antibodies anti-proprotein convertase subtilisin/kexin type 9 (PCSK9) and ezetimibe, in patients under statin therapy, have been proven by specific RCT, while we are still waiting for the results of bempedoic acid and the small-interfering RNA (si-RNA) anti-PCSK9 inclisiran. Taken together, the approval of new pharmacological agents to be used in combination with statins represents the future for a tailored therapy of cardiovascular disease patients.
他汀类药物是治疗高胆固醇血症的基石，但由于肌肉相关的副作用和葡萄糖代谢紊乱，极大地限制了其在一级预防治疗中的应用和依从性。本综述的目的是提供他汀类药物单药治疗或与新型降脂药物联合治疗的最新疗效和安全性证据。
最近发表了关于年轻家族性高胆固醇血症患者、老年低胆固醇血症患者和随机对照试验（RCT） 20 年随访的“终身”分析结果，证实了他汀类药物治疗的心血管益处，对于符合当前指南推荐的患者，其益处远远超过副作用的风险。此外，最近与他汀类药物联合使用的治疗方法显示，可增加低密度脂蛋白胆固醇（LDL-C）达标患者的百分比，且安全性良好。针对他汀类药物治疗患者的单克隆抗体抗前蛋白转化酶枯草溶菌素 9（PCSK9）和依折麦布的心血管（CV）获益已通过特定的 RCT 得到证实，而我们仍在等待苯扎贝特酸和小干扰 RNA（si-RNA）抗 PCSK9 inclisiran 的结果。综上所述，新的联合他汀类药物使用的药物的批准代表了心血管疾病患者个体化治疗的未来。
