Therapeutic combination of "keys" to target low-density lipoprotein cholesterol level

Abstract

This article updates the continuing high prevalence of lipid metabolism disorders and their connection with the development of cardiovascular pathology associated with atherosclerosis. Attention is focused on the existing lack of adherence to the correction of dyslipidemia, both on the part of patients and medical workers, as well as the problem of failure to achieve target levels of low-density lipoprotein cholesterol with standard statin treatment. The evolution of modern therapy for lipid metabolism disorders is shown and the feasibility of early initiation of combination treatment in patients with very high and high cardiovascular risk in the presence of severe dyslipidemia is substantiated, and possible treatment strategies existing in current recommendations are outlined. In the presented work, using the example of an outpatient 54 years old after undergoing stenting of the coronary arteries, who has a very high cardiovascular risk (established diagnoses of coronary heart disease, post-infarction cardiosclerosis, hypertension) with failure to achieve the target level of low-density lipoprotein cholesterol of less than 1.4 mmol/l The therapeutic effectiveness of a double combination – an inhibitor of cholesterol absorption in the intestine – ezetimibe at a dose of 10 mg with a statin at the maximum tolerated dosage was demonstrated. It has been shown that the proposed combined lipid-lowering treatment is clinically and laboratory safe. Arguments in favor of starting combination treatment in this clinical case include not only the failure to achieve the target value of low-density lipoprotein cholesterol on high-intensity statin monotherapy as part of secondary prevention and possible familial hypercholesterolemia, but also a hereditary history of cardiovascular pathology, early onset of cardiovascular diseases in patient.