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[Importance of dyslipidaemia in cardiovascular disease: a point of view]
Juan F Ascaso1, Rafael Carmena2
1Hospital Clínico Universitario, INCLIVA, CIBERDEM, Departamento de Medicina, Universitat de Valencia, Valencia, España; Presidente de la Sociedad Española de Arteriosclerosis, España.
Insights
Lipid control is key for preventing cardiovascular diseases, focusing on LDL-C goals. For metabolic syndrome, apoB or Non-HDL-C targets are crucial, alongside lifestyle changes and medications like statins.
Area of Science:
- Cardiology
- Preventive Medicine
- Lipidology
Background:
- Cardiovascular diseases (CVD) remain a leading cause of mortality globally.
- Effective prevention strategies are crucial for public health.
- Current European guidelines (ESC/EAS) provide a framework for CVD prevention.
Purpose of the Study:
- To present a viewpoint on cardiovascular disease prevention aligned with ESC/EAS guidelines.
- To emphasize the importance of lipid control, particularly LDL-C, in CVD prevention and treatment.
- To highlight specific lipid targets (apoB, Non-HDL-C) for individuals with metabolic syndrome.
Main Methods:
- Review and interpretation of current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines.
- Discussion of therapeutic strategies for lipid management.
- Consideration of risk stratification and pharmacological interventions.
Main Results:
- Lipid control, guided by LDL-C goals, is essential for CVD prevention and treatment.
- For metabolic syndrome, apoB or Non-HDL-C are superior markers of cardiovascular risk.
- Statins are the primary pharmacologic intervention, with additions like ezetimibe, resins, PCSK-9 inhibitors, fibrates, or omega-3 as needed.
- Treatment is effective across all populations and age groups, with individualized assessment for those over 80.
Conclusions:
- Adherence to lipid targets is fundamental in managing cardiovascular risk.
- Personalized treatment approaches, including lifestyle modifications and pharmacotherapy, are vital.
- Emerging therapies like PCSK-9 inhibitors offer new options for high-risk individuals.
Abstract:
The authors present their view on the prevention of cardiovascular diseases, accepting the European ESC/EAS guidelines. They consider that the aim of the lipid control, based on LDL-C goals, is essential for the prevention and treatment of cardiovascular diseases. In subjects with metabolic syndrome (mainly, abdominal obesity, pre-diabetes and diabetes), the primary objective should be apoB or Non-HDL-C, which are better associated with cardiovascular risk. The treatment must be lifestyle changes and control of other risk factors. After calculating cardiovascular risk, statins are the first therapeutic step, with the strength and dose needed to achieve LDL-C goals. If targets are not achieved, ezetimibe or resins should be added. A new group of potent cholesterol-lowering agents, the PCSK-9 monoclonal antibodies, have recently been approved in Spain. Subjects at very high cardiovascular risk that have achieved LDL-C goals, or other objectives (apoB, Non-HDL-C), other drugs (fibrates, omega-3) capable of modifying triglycerides and HDL-C could be added, if necessary. Treatment to reduce cardiovascular risk and prevent cardiovascular disease has proven effective in all populations and at all age groups. Subjects older than 80years should be individually assessed, taking into consideration possible comorbidities.
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