An updated review of lipid‐modifying therapy

Abstract

Summary Statin drugs reduce low‐density lipoprotein (LDL)‐cholesterol (LDL‐C) and cardiovascular risk. Ezetimibe may be used to supplement statin therapy, or used alone in cases of statin intolerance. Statin‐associated side effects do occur, especially muscle symptoms and new onset diabetes, but they do not detract from the benefits of statin therapy. Inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce LDL‐C and cardiovascular risk. Evolocumab is subsidised in Australia for patients with familial hypercholesterolaemia when LDL‐C is not adequately controlled with maximum doses of statin or ezetimibe or when statin therapy is contraindicated. Fenofibrate reduces triglycerides and cardiovascular risk in patients with type 2 diabetes when triglycerides are elevated and high‐density lipoprotein (HDL) is low. A role for dietary omega‐3 fatty acids and esters in reducing cardiovascular risk remains controversial. All cases of secondary cardiovascular disease prevention merit intensive lipid therapy, unless a contraindication exists. Lipid therapy is justified in cases of primary prevention when absolute risk is high, especially when lipids are highly elevated or when multiple risk factors are present. Clinical management requires a focus on the predominant lipid disorder present, namely hypercholesterolaemia, hypertriglyceridaemia or combined hyperlipidaemia. There is an ongoing problem of poor long term persistence on lipid therapy, as well as reduced awareness by practitioners of poor risk factor control.

Serum Metabolomics Reveals Underlying Mechanisms of Cholesterol‐Lowering Effects of Oat Consumption: A Randomized Controlled Trial in a Mildly Hypercholesterolemic Population

“…[6][7][8][9] They also suggest that modifications in dietary habits and lifestyle have crucial roles in reducing the risk of CVDs through a variety of mechanisms and are much more important than genetic factors. [10][11][12] American Heart Association guidelines for management of blood cholesterol levels are consistent with these findings. [13] Epidemiological studies and meta-analysis have consistently found a negative association between the risk of CVDs and whole-grain consumption.…”

“…[ 6–9 ] They also suggest that modifications in dietary habits and lifestyle have crucial roles in reducing the risk of CVDs through a variety of mechanisms and are much more important than genetic factors. [ 10–12 ] American Heart Association guidelines for management of blood cholesterol levels are consistent with these findings. [ 13 ]…”

Evolving worldwide approaches to lipid management and implications for Australian general practice

“…15 Duration of treatment brings cumulative benefit, especially when started early in life. 5,15,42,43 Future medications that target…”

“…Statin adherence and persistence is often poor, lacking patient benefit if not taken. 42 Initial patientdoctor discussion should seek consensus on treatment need, stratification of risk involved as well as planned approach involving diet, regular exercise, lifestyle changes and potential pharmacotherapy. Supportive counselling from pharmacists as well as new electronic reminder devices, including texting, can also help adherence.…”

NMR-based metabolomic profile of hypercholesterolemic human sera: Relationship with in vitro gene expression?

“…Cholesterol is deeply involved in numerous molecular mechanisms leading to vascular damage; therefore, its concentration is widely used as a diagnostic clinical parameter to assess atherosclerotic disease and risk [2]. Most importantly, backgrounds of hypercholesterolemia can be mainly separated between those deriving from lifestyle, with a significant role of the quality and quantity of nutritional intake, and, much less frequently, those deriving from genetic factors [3].…”