Modern possibilities of intensive treatment of dyslipidemia and gaps in its control: literature review

Abstract

The article discusses modern approaches to screening for dyslipidemia and its control, target levels of low-density lipoproteins (LDL), initiation of lipid-lowering therapy depending on the total risk on the Systematic Coronary Risk Evaluation (SCORE) scale, considering the effects of age, gender, smoking, blood pressure, lipid levels, which are of crucial importance for selecting preventive and therapeutic strategies in patients with several risk factors. Different types of therapy for dyslipidemia are discussed as of monotherapy with statins and, in combination with ezetimibe, inhibitors of the enzyme proprotein convertase subtilisin-kexin type 9 (PCSK9). New lipid-lowering drugs are highlighted: bempedoic acid and inclisiran, a synthetic small interfering RNA (siRNA) conjugated with a hydrocarbon of three-antennary N-acetylgalactosamine, which activates the natural RNA interference mechanism to cleave the mRNA of the PCSK9 enzyme and prevent its translation into a protein molecule. This increases the number of receptors for LDL and reducing their amount in the blood. We present our results of assessing the use of lipid-lowering therapy and achievement of the target LDL value in very high-risk patients. Innovative biotechnological drugs based on human monoclonal antibodies or antisense oligonucleodins create additional opportunities for improving the treatment of statin-resistant forms of dyslipidemia in patients with a very high cardiovascular risk. The article aims to increase the level of knowledge about modern approaches to lipid-lowering therapy of general practitioners, cardiologists of the primary care settings and will be of interest to other specialists.