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Hypercholesterolemia and cardiovascular disease: Focus on high cardiovascular risk patients
Gerald F Watts1, Alberico L Catapano2, Luis Masana3
1Department of Cardiology,Royal Perth Hospital, School of Medicine, University of Western, Australia.
Insights
Many patients struggle to reach cholesterol targets with statins. Aggressive LDL-C reduction is crucial for very high cardiovascular risk patients, especially those with comorbidities like diabetes.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Statins have improved hypercholesterolemia treatment but many patients don't meet LDL-C targets.
- Very high cardiovascular (CV) risk patients, particularly those with comorbidities like diabetes or peripheral artery disease, require intensified lipid-lowering strategies.
Purpose of the Study:
- To review current European guidelines on LDL-C goals for very high CV risk patients.
- To explore the role of patient stratification in identifying individuals who benefit from aggressive LDL-C reduction.
Main Methods:
- Analysis of recent clinical trial data on patient stratification and LDL-C lowering.
- Review of European Society of Cardiology (ESC) guidelines regarding lipid targets.
Main Results:
- Current guidelines recommend at least 50% LDL-C reduction, with goals <55 mg/dL or <40 mg/dL for very high-risk individuals.
- Patient stratification based on atherothrombotic risk factors can identify those who may benefit from more intensive LDL-C lowering.
Conclusions:
- Aggressive LDL-C lowering, potentially below guideline targets, is appropriate for select very high CV risk patients.
- Pharmacological approaches should be tailored to achieve the lowest possible LDL-C levels in these high-risk populations.
Abstract:
The widespread use of statins has largely improved the treatment of hypercholesterolemia, but many patients still fail to achieve the LDL-C targets recommended by guidelines. Furthermore, some patients continue to present a very high cardiovascular (CV) risk or even an extreme risk despite being well treated, mainly due to the presence of co-morbidities such as diabetes or peripheral artery disease, which significantly increase their global CV risk. For these very high CV risk patients, the most recent European guidelines have reviewed the LDL-C goals and recommend an LDL-C reduction of at least 50% and a goal of <55 mg/dL or even <40 mg/dL. Recent clinical trials have shown that patient stratification based on the presence or absence of atherothrombotic risk factors may represent a valuable tool to identify patients at extremely high CV risk who may benefit more from an aggressive LDL-C-lowering approach. In these patients it may be appropriate to aim for the lowest LDL-C level, independently of recommended goals, with all the available pharmacological approaches.
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