Unidad de Lípidos y Arteriosclerosis, Departamento de Medicina Interna, Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Córdoba, España.
Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España.
Clin Investig Arterioscler. 2021 May;33 Suppl 1:46-52. doi: 10.1016/j.arteri.2020.12.005.
The use of low-density lipoprotein cholesterol (LDLc)-lowering medications has led to a significant reduction of cardiovascular risk in both primary and secondary prevention. Statins represent the cornerstone of lipid-lowering treatment and substantially decreases cardiovascular morbidity and mortality. However, there are still unmet clinical needs in the management of dyslipidaemia. Indeed, it is difficult to achieve LDLc targets in many patients, particularly in those at high/very high cardiovascular risk and in those with very high baseline LDLc concentrations. Moreover, a considerable proportion of patients are unable to tolerate maximum statin doses, mostly due to muscle-related adverse effects. In the present narrative review, a summary is presented on the current knowledge on the effects of the different cholesterol-lowering drugs, including those recently approved by European and American regulatory agencies, on lipid profile, and on cardiovascular risk. Since difficult-to-treat patients may benefit from new combination therapies as a result of the emergence of new drugs with clinical evidence, updates of the clinical guidelines would be recommended.
使用降低低密度脂蛋白胆固醇（LDLc）的药物已显著降低了一级和二级预防中的心血管风险。他汀类药物是降脂治疗的基石，可大幅降低心血管发病率和死亡率。然而，在血脂异常的管理方面仍存在未满足的临床需求。实际上，许多患者难以达到 LDLc 目标，尤其是在心血管风险高/极高和基线 LDLc 浓度非常高的患者中。此外，相当一部分患者不能耐受最大剂量的他汀类药物，主要是由于肌肉相关的不良反应。在本叙述性综述中，总结了不同降脂药物（包括最近获得欧美监管机构批准的药物）对血脂谱和心血管风险的影响的现有知识。由于新型药物具有临床证据，因此难以治疗的患者可能会从新的联合疗法中受益，因此建议更新临床指南。
