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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
Beyond statins: lipid management to reduce cardiovascular risk
Robert N Schuck1, Philip M Mendys, Ross J Simpson
1Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.
Insights
Statins are the primary treatment for high cholesterol and cardiovascular disease (CVD) risk. This review examines non-statin drugs for patients needing additional lipid management or statin intolerance.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Elevated cholesterol, particularly low-density lipoprotein (LDL) cholesterol, is a significant risk factor for cardiovascular disease (CVD).
- Lipid management strategies have reduced CVD burden, but optimal approaches for further risk reduction remain debated.
- Statins are the established first-line therapy for hyperlipidemia in high-risk patients.
Purpose of the Study:
- To review clinical trial evidence on second-line antihyperlipidemic drugs for cardiovascular risk reduction.
- To offer recommendations for the appropriate use of non-statin lipid-altering medications.
- To identify future research directions in evidence-based lipid management.
Main Methods:
- Systematic review of clinical trial data on antihyperlipidemic drug efficacy.
- Analysis of evidence for non-statin therapies in hyperlipidemia management.
- Synthesis of current research to inform future therapeutic strategies.
Main Results:
- Statins are the primary agents for high-risk patients.
- Optimal lipid management for statin-intolerant or add-on therapy patients is controversial.
- Evidence for second-line antihyperlipidemic drugs is being evaluated.
Conclusions:
- Further research is needed to optimize lipid management strategies.
- Improved processes of care and novel therapeutic options are essential for reducing CVD.
- Non-statin lipid-altering drugs play a role in complex hyperlipidemia cases.
Abstract:
The discovery that elevated total cholesterol levels and the subsequent understanding that low-density lipoprotein cholesterol levels are associated with higher risk for cardiovascular disease (CVD) has led to the development of lipid management strategies that seek to reduce the burden of CVD. Although substantive progress has been made in reducing death and cardiovascular events, questions remain regarding the optimal approach to further reduce CVD-associated death and disability. Based on current evidence, statins are the clear first-line agents for the management of hyperlipidemia in patients at high risk for cardiovascular events. However, due to the failure of recent clinical trials evaluating antihyperlipidemic drugs, the most appropriate lipid management strategy in patients who cannot tolerate statin therapy or who warrant antihyperlipidemic therapies in addition to statins is a major therapeutic controversy. In this review, we summarize the clinical trial evidence evaluating the efficacy of second-line antihyperlipidemic drug classes for reducing cardiovascular risk, provide recommendations for appropriate use of nonstatin lipid-altering drugs, and identify key areas of future research to support evidence-based lipid management. Given the complexity, magnitude, and burden of CVD, opportunities to improve processes of care and identify new therapeutic options clearly exist.
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