[Hypercholesterolemia and cardiovascular risk]

Area of Science:

• Cardiology
• Pharmacology
• Lipid Metabolism

Context:

• Pharmacological reduction of LDL-cholesterol (LDL-C) is a cornerstone in managing atherosclerotic cardiovascular disease (ASCVD) risk.
• Statins are the primary therapy, but novel non-statin agents like ezetimibe, bempedoic acid, and PCSK9 inhibitors also reduce cardiovascular risk.
• A gap exists between recommended LDL-C goals and real-world achievement, often due to underutilization of non-statin therapies.

Purpose:

• To highlight the importance of pharmacological LDL-C reduction in ASCVD risk management.
• To discuss the role of statins and emerging non-statin therapies.
• To emphasize the need for combination therapy to overcome treatment gaps.

Summary:

• Statins are the mainstay for lowering LDL-cholesterol (LDL-C) to reduce atherosclerotic cardiovascular disease (ASCVD) risk.
• Ezetimibe, bempedoic acid, and PCSK9 inhibitors offer additional LDL-C lowering and cardiovascular risk reduction.
• Limited use of these novel non-statin therapies contributes to a treatment gap, hindering achievement of guideline-recommended LDL-C goals.

Impact:

• Combination lipid-lowering therapy should be considered the standard of care for very high-risk ASCVD patients.
• Achieving LDL-C treatment goals through comprehensive strategies can ultimately reduce cardiovascular events.
• Optimizing lipid management is essential for improving patient outcomes and preventing cardiovascular morbidity and mortality.