Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Department of Hypertension, Medical University of Lodz (MUL), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland.
School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK.
Pharmacol Res. 2021 Apr;166:105499. doi: 10.1016/j.phrs.2021.105499. Epub 2021 Feb 17.
Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.
动脉粥样硬化性心血管疾病（ASCVD）和随后的急性冠状动脉综合征（ACS）是欧洲发病率和死亡率的主要原因。这些疾病的大部分负担是可以改变的，特别是通过降脂治疗（LLT）。目前的指南基于一个合理的前提，即对于低密度脂蛋白胆固醇（LDL-C），“越低越好，时间越长越好”，最近的数据强烈强调了“越早越好”的必要性。除了几十年来一直可用的他汀类药物外，依折麦布和前蛋白转化酶枯草溶菌素/激肽释放酶 9（PCSK9）抑制剂的可用性也是 LLT 的另一种非常有效的方法，特别是对于那些具有极高和极高心血管风险的患者。LLT 是作为对个体未来 ASCVD 风险的计算反应而开始的，并随着时间的推移而加强，以达到治疗目标。然而，在现实的临床实践中，相当一部分患者的目标没有达到。本立场文件补充了关于 ACS 后患者血脂管理的现有指南。鉴于 ACS 后进一步发生事件的风险非常高，我们提出了一些实用的解决方案，重点关注严格的临床情况下的立即联合治疗，以提高这些患者对 LLT 的依从性。我们还定义了 ACS 后一个“极高风险”的个体群体，完成了最近欧洲指南中的尝试，并提出了在这些患者中紧急解决脂质介导的心血管风险的机制。
