Individualized lipid-lowering therapy to further reduce residual cardiovascular risk

Area of Science:

• Cardiology
• Metabolic Disorders
• Pharmacology

Background:

• Hypercholesterolemia is a significant risk factor for cardiovascular diseases (CVD).
• Serum cholesterol levels are influenced by absorption, biliary secretion, and hepatic synthesis.
• Statins, by inhibiting HMG-CoA-reductase, lower cholesterol and reduce CVD events.

Purpose of the Study:

• To review current literature on hypercholesterolemia management.
• To discuss the limitations of current therapies, including statins.
• To propose individualized lipid-lowering therapy for optimizing treatment and reducing residual CVD risk.

Main Methods:

• Review of current scientific literature on hypercholesterolemia and lipid-lowering therapies.
• Analysis of factors influencing statin response, such as cholesterol absorption.
• Discussion of alternative and combination therapies like NCP1L1 inhibitors, PCSK9 antibodies, and lipid apheresis.

Main Results:

• Patients with high cholesterol absorption may respond less effectively to statins alone.
• Reducing intestinal cholesterol absorption (e.g., via NCP1L1) offers additional cardiovascular risk reduction.
• Some patients require combination therapy or advanced treatments to reach LDL-cholesterol targets.

Conclusions:

• Individualized lipid-lowering therapy is crucial for optimizing treatment in hypercholesterolemia.
• Personalizing treatment based on factors like cholesterol absorption can improve outcomes.
• This approach aims to further reduce residual cardiovascular risk in patients with hypercholesterolemia.