Evidence for more intensive cholesterol lowering

Soran, Handrean; Kwok, See; Adam, Safwaan; Ho, Jan Hoong; Durrington, Paul N.

doi:10.1097/mol.0000000000000433

Cited by 15 publications

(10 citation statements)

References 35 publications

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“…Pertinently, in another coronavirus related disease, Middle Eastern Respiratory Syndrome (MERS), statins were postulated to protect against mortality [ 46 ]. There are also some studies which have shown a beneficial role of statins in sepsis [ 47 ], and this is not unfounded given their anti-oxidant, anti-inflammatory and immunomodulatory properties [ 48 , 49 ]. Longer-term data are required, however, before such claims can be substantiated.…”

Section: Recommendationsmentioning

confidence: 99%

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Iqbal

Adam

et al. 2020

Atherosclerosis

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Background & aims The emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes Coronavirus Disease 2019 (COVID-19) has resulted in a worldwide pandemic. SARS-CoV-2 is highly contagious and its severity highly variable. The fatality rate is unpredictable but is amplified by several factors including advancing age, atherosclerotic cardiovascular disease, diabetes mellitus, hypertension and obesity. A large proportion of patients with these conditions are treated with lipid lowering medication and questions regarding the safety of continuing lipid-lowering medication in patients infected with COVID-19 have arisen. Some have suggested they may exacerbate their condition. It is important to consider known interactions with lipid-lowering agents and with specific therapies for COVID-19. This statement aims to collate current evidence surrounding the safety of lipid-lowering medications in patients, who have COVID-19. We offer a consensus view based on current knowledge and we rated the strength and level of evidence for these recommendations. Methods Pubmed, Google scholar and Web of Science were searched extensively for articles using search terms: SARS-CoV-2, COVID-19, coronavirus, Lipids, Statin, Fibrates, Ezetimibe, PCSK9 monoclonal antibodies, nicotinic acid, bile acid sequestrate, nutraceuticals, red yeast rice, Omega-3-Fatty acids, Lomitapide, hypercholesterolaemia, dyslipidaemia and Volanesorsen. Results & Conclusions : There is no evidence currently that lipid lowering therapy is unsafe in patients with COVID-19 infection. Lipid-lowering therapy should not be interrupted because of the pandemic or in patients at increased risk of COVID-19 infection. In patients with confirmed COVID-19, care should be taken to avoid drug interactions, between lipid-lowering medications and drugs that may be used to treat COVID-19, especially in patients with abnormalities in liver function tests.

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Section: Recommendationsmentioning

confidence: 99%

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Iqbal

Adam

et al. 2020

Atherosclerosis

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“…Furthermore, while current guidance specifies situations where specialist support should be sought, there is presently no specific definition of a "specialist" within the guidelines. 9 The subsequent interpretation of this guidance and associated referral processes Table 2 Possible Strategies to Improve Adherence with Cholesterol Goals 4,9,22,33,[35][36][37][38][39][40][41][42] Possible Cause(es) for Failure to Meet…”

Section: Future Considerationsmentioning

confidence: 99%

“…26,31 Failure to attain cholesterol/non-HDL-C/LDL-C reduction goals may also be attributed to a variety of other factors, including poor adherence and statin intolerance, which could require alternative approaches in order to personalize patient care and minimize CVD risk. Healthcare professionals may, therefore, benefit from improved • Measure statin response more proactively and, where appropriate in poor responders, consider more aggressive therapy either with lipid lowering therapy, diet or improved adherence 40 • Consider patient eligibility for combined therapy (eg adding ezetimibe to statin therapy), or other non-statin therapies (eg PCSK9 inhibitors or other newly licensed agents) for those on maximum tolerated statin dose or when absolute risk requires it (eg LDL-C >4 mmol/liter) 41,42 https://doi.org/10.2147/VHRM.S269879…”

Section: Underdosing Of Statinsmentioning

confidence: 99%

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Reynolds¹,

Pottle²,

Quoraishi³

2021

VHRM

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Despite widespread evidence of the effectiveness of lipid modification for the reduction of cardiovascular disease (CVD) risk, lipid modification goals are commonly underachieved in the United Kingdom (UK). In order to understand current UK lipid management guidance and the corresponding attainment of recommended lipid lowering goals relating to treatment with statins and ezetimibe, a literature review was conducted using PubMed focusing on publications between January 2017 and February 2020 in order to capture the most up-to-date literature. Identified publications were reviewed against key clinical guidelines for lipid management in relation to CVD risk from the National Institute for Health and Care Excellence (NICE, CG181), the Scottish Intercollegiate Guidelines Network (SIGN, 149) and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS). Cholesterol lowering goals are central to current lipid lowering therapy guidance, although specific goals vary depending on the guideline and patients' individual risk profile. Current guidance by NICE and SIGN specifies that treatment should achieve a greater than 40% reduction in non-high-density lipoprotein cholesterol (non-HDL-C) at 3 months of treatment, while the ESC/EAS place emphasis on the lowering of lowdensity lipoprotein (LDL-C) and total cholesterol. Yet, despite widespread availability of guidance and consistent messaging that lipid lowering goals should be ambitious, current evidence suggests a significant proportion of UK patients have sub-optimal reductions in cholesterol/non-HDL-C/LDL-C. The reasons for this are reported to be multifactorial, including a lack of compliance with guidelines, particularly regarding high-intensity statin prescribing, patient adherence, statin intolerance and statin reluctance as well as wider genetic factors. A number of possible strategies to improve current lipid management and attainment of lipid-lowering goals were identified, including improving the patient-healthcare professional partnership, conducting audits of local prescribing versus guidance, implementing plans for the refinement of current services and considering alternative options such as cost-effective single pill combinations for improving adherence.

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“… Association between cardiovascular risk reduction and absolute reduction in low density lipoprotein cholesterol in major randomised control trials [ 67 , 75 , 81 , 82 , 85 ]. Adapted from Soran et al [ 75 ] (where full list of additional individual trial references can be found). There is a consistent reduction in cardiovascular risk of about one-fifth for every 1 mmol/l (38 mg/dl) reduction in LDL-C …”

Section: Ldl-c Targets: How Low Should We Go?mentioning

confidence: 99%

“…There is gathering evidence that lower LDL-C levels than have been traditionally championed may have a significant impact on CVD-related mortality, in particular in high-risk patients and/or those with the highest pre-treatment LDL-C [ 75 , 76 , 92 ]. As a result, clinical guidelines of LDL-C targets may change which will affect the threshold at which to start lipid modifying treatment when considering that the Number Needed to Treat (NNT) to achieve benefit depends on the absolute reduction in LDL-C [ 75 , 76 , 92 , 93 ].…”

Section: Ldl-c Targets: How Low Should We Go?mentioning

confidence: 99%

Hypercholesterolaemia – practical information for non-specialists

Soran¹,

Adam²,

Mohammad³

et al. 2018

aoms

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Hypercholesterolaemia is amongst the most common conditions encountered in the medical profession. It remains one of the key modifiable cardiovascular risk factors and there have been recent advances in the risk stratification methods and treatment options available. In this review, we provide a background into hypercholesterolaemia for non-specialists and consider the merits of the different risk assessment tools available. We also provide detailed considerations as to: i) when to start treatment, ii) what targets to aim for and iii) the role of low density lipoprotein cholesterol.

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Evidence for more intensive cholesterol lowering

Abstract: We conclude that when initial LDL cholesterol exceeds 4 mmol/l and absolute CVD risk demands it, a target value of 1.8 mmol/l should be achieved, if necessary by adding ezetimibe and/or PCSK9 inhibitors to statin treatment.

Cited by 15 publications

References 35 publications

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Managing hyperlipidaemia in patients with COVID-19 and during its pandemic: An expert panel position statement from HEART UK

Current Perspectives on the Attainment of Lipid Modification Goals Relating to the Use of Statins and Ezetimibe for the Prevention of Cardiovascular Disease in the United Kingdom

Hypercholesterolaemia – practical information for non-specialists

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