[Therapy of dyslipidemia in post-infarction: state of the art]

Area of Science:

• Cardiovascular Medicine
• Metabolic Disorders
• Pharmacology

Context:

• Atherogenesis is significantly influenced by LDL-cholesterol, a primary risk factor for cardiovascular events.
• Current guidelines recommend aggressive LDL-cholesterol reduction, targeting levels below 100 mg/dl and even below 70 mg/dl for high-risk patients.
• Existing treatments, including lifestyle changes and drugs like statins, fibrates, resins, and nicotinic acid, have limitations in achieving target LDL-cholesterol levels in many high-risk individuals.

Purpose:

• To highlight the critical role of LDL-cholesterol in atherogenesis and cardiovascular disease.
• To review current therapeutic strategies for dyslipidemia, including lifestyle modifications and pharmacological interventions.
• To introduce and evaluate innovative combination therapies for hypercholesterolemia.

Summary:

• LDL-cholesterol is a critical determinant in atherogenesis and a primary target for reducing cardiovascular and total mortality.
• Therapeutic lifestyle changes and pharmacological agents (statins, fibrates, resins, nicotinic acid) are mainstays of dyslipidemia treatment.
• Standard statin therapy often fails to achieve target LDL-cholesterol levels in half of high-risk patients, necessitating novel approaches.
• A combination therapy inhibiting both cholesterol synthesis (statins) and absorption (ezetimibe) represents an innovative strategy for managing hypercholesterolemia.

Impact:

• Aggressive LDL-cholesterol reduction is essential for secondary prevention of coronary heart disease.
• The limitations of current therapies underscore the need for more effective treatments to achieve lipid goals.
• Combination therapy with statins and ezetimibe offers a promising advancement in hypercholesterolemia management, potentially improving cardiovascular outcomes.