Banach Maciej, Reiner Željko, Surma Stanisław, Bajraktari Gani, Bielecka-Dabrowa Agata, Bunc Matjaz, Bytyçi Ibadete, Ceska Richard, Cicero Arrigo F G, Dudek Dariusz, Dyrbuś Krzysztof, Fedacko Jan, Fras Zlatko, Gaita Dan, Gavish Dov, Gierlotka Marek, Gil Robert, Gouni-Berthold Ioanna, Jankowski Piotr, Járai Zoltán, Jóźwiak Jacek, Katsiki Niki, Latkovskis Gustavs, Magda Stefania Lucia, Margetic Eduard, Margoczy Roman, Mitchenko Olena, Durak-Nalbantic Azra, Ostadal Petr, Paragh Gyorgy, Petrulioniene Zaneta, Paneni Francesco, Pećin Ivan, Pella Daniel, Postadzhiyan Arman, Stoian Anca Pantea, Trbusic Matias, Udroiu Cristian Alexandru, Viigimaa Margus, Vinereanu Dragos, Vlachopoulos Charalambos, Vrablik Michal, Vulic Dusko, Penson Peter E
Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Rzgowska 281/289, 93-338, Lodz, Poland.
Division of Cardiology, Department of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Drugs. 2024 Dec;84(12):1541-1577. doi: 10.1007/s40265-024-02105-5. Epub 2024 Nov 4.
Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's 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 recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.
动脉粥样硬化性心血管疾病（ASCVD）及随之而来的急性冠脉综合征（ACS）是欧洲发病率和死亡率的主要成因。幸运的是，该疾病多达三分之二的负担是可以改变的，尤其是通过降脂治疗（LLT）。当前指南基于一个合理的前提，即就低密度脂蛋白胆固醇（LDL-C）而言，“越低越好，且维持时间越长越好”，并且近期数据强烈强调了“越早越好”的必要性。除了已应用数十年的他汀类药物外，依折麦布、贝派地酸（也有固定剂量复方制剂）以及前蛋白转化酶枯草溶菌素/kexin 9型（PCSK9）抑制剂（如inclisiran）是LLT的另外几种非常有效的方法，尤其适用于心血管风险极高和极高的患者。然而在现实生活中，相当一部分患者（甚至70%的患者）仍未达到临床实践目标。不过，凭借现有的治疗选择，我们应使脂质紊乱成为罕见疾病。2021年4月，国际脂质专家小组（ILEP）发表了首份关于ACS后患者LLT最佳应用的立场文件，该文件补充了现有的ACS后患者脂质管理指南，后者定义了一组“极高风险”个体，并概述了应考虑采用初始联合治疗以改善LLT的可及性和依从性从而提高治疗效果的情形。这些更新后的建议基于此前的工作，同时考虑了联合LLT证据基础的发展、脂质紊乱治疗作用的持续教育以及降脂药物可及性的变化。我们的目标是提供一份指南来满足这一未被满足的临床需求，提供清晰实用的建议，同时承认以患者为中心的护理的必要性，并考虑到各国LLT可及性通常存在的巨大差异。
