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Saturday 27 April 2024

Peer Reviewed

Feature Article Cardiovascular medicine

Lipid management – what’s hot and what’s not?

Leon A Simons

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Abstract

Statin therapy reduces the risk of cardiovascular disease, but significant residual cardiovascular risk still remains. A larger reduction in cardiovascular risk could be achieved by a more comprehensive management of patients’ lipid profiles.

Key Points

Statin therapy reduces the risk of cardiovascular disease (CVD) by 20 to 30% (relative risk reduction), but significant residual cardiovascular risk remains. This may be addressed, in part, by more intensive statin therapy.
Supplementary ezetimibe should continue to be used in patients who are not achieving relevant target low density lipoprotein cholesterol (LDL-C) levels on maximum tolerated doses of a statin, pending the availability of further outcome data.
Compliance should be confirmed in patients who are not at goal LDL-C levels after use of a statin and ezetimibe in proper dosage. A third drug such as fenofibrate 145 mg daily or low-dose cholestyramine 8 g daily could then be prescribed to reduce LDL-C levels further. This approach should be reserved for high-risk patients who are strongly motivated.
In patients with triglyceride levels of 2.3 mmol/L or more, fibrates can be prescribed as a supplement to statins.