Sinning David, Landmesser Ulf
Dtsch Med Wochenschr. 2023 Aug;148(16):1025-1032. doi: 10.1055/a-1932-6448. Epub 2023 Aug 4.
Pharmacological reduction of LDL-cholesterol (LDL-C) is a major treatment strategy in limiting atherosclerotic cardiovascular (ASCVD) risk. Statins remain the primary therapeutic cornerstone in ASCVD prevention. Furthermore, ezetimibe, bempedoic acid, and PCSK9 inhibition have recently also shown to reduce cardiovascular risk. Unfortunately, a treatment gap remains between guideline-recommended LDL-C goals and what is achieved in real-world practice. An important reason for this is the limited use of novel and effective non-statin lipid-lowering therapies. In order to achieve LDL-C treatment goals and, ultimately, reduction of cardiovascular events, a combination lipid-lowering therapy needs to be considered as the standard of care for patients at very high cardiovascular risk.
降低低密度脂蛋白胆固醇(LDL-C)的药理学方法是限制动脉粥样硬化性心血管疾病(ASCVD)风险的主要治疗策略。他汀类药物仍然是预防ASCVD的主要治疗基石。此外,依折麦布、贝派地酸和前蛋白转化酶枯草杆菌蛋白酶kexin 9型(PCSK9)抑制剂最近也显示出可降低心血管风险。不幸的是,在指南推荐的LDL-C目标与实际临床实践所达到的目标之间仍存在治疗差距。造成这种情况的一个重要原因是新型有效非他汀类降脂疗法的使用有限。为了实现LDL-C治疗目标并最终减少心血管事件,联合降脂治疗应被视为心血管风险极高患者的标准治疗方案。