The future of pharmacological therapy for risk factor reduction. Hyperlipidaemia

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Hyperlipidemia management requires lifelong drug treatment.
• Guidelines for drug treatment of hyperlipidemia have been established by the European Atherosclerosis Society.
• Drug therapy should only be initiated after excluding secondary causes, failure of dietary interventions, and careful individual assessment.

Purpose of the Study:

• To outline the criteria for selecting plasma lipid-lowering drugs.
• To classify current hyperlipidemia drugs into first- and second-line treatments.
• To discuss the potential for newer lipid-lowering drugs to become first-line therapies.

Main Methods:

• Review of European Atherosclerosis Society guidelines for hyperlipidemia drug treatment.
• Evaluation of drugs based on long-term efficacy, compliance, clinical endpoint effect, and safety.
• Classification of drugs into first- and second-line categories.

Main Results:

• First-line drugs currently include cholestyramine, nicotinic acid, and gemfibrozil.
• Second-line drugs include lovastatin, simvastatin, probucol, and "third generation" fibrates.
• Newer drugs like lovastatin, simvastatin, and probucol show promise for future first-line use due to better patient compliance.

Conclusions:

• Long-term efficacy, safety, and patient compliance are crucial for selecting hyperlipidemia drugs.
• Current guidelines categorize drugs, with a trend towards incorporating newer, more compliant options as first-line treatments.
• Continued research and experience may lead to a shift in first-line hyperlipidemia drug recommendations.