LDL cholesterol target attainment in cardiovascular high- and very-high-risk patients with statin intolerance: a simulation study

Scientific Reports, Journal Year: 2024, Volume and Issue: 14(1)

Published: Jan. 4, 2024

The inability to tolerate sufficient doses of statins, statin intolerance (SI), contributes the non-achievement guideline-recommended low-density lipoprotein cholesterol (LDL-C) treatment targets. Patients with SI require alternative lipid-lowering therapies (LLT). We conducted a simulation study on LDL-C target achievement oral LLT (ezetimibe, bempedoic acid) in patients SI, using representative data 2.06 million German outpatients. was defined literature-informed definitions based electronic medical records (EMR). Among n = 130,778 hypercholesterolaemia, available measurement, and high or very-high cardiovascular risk, 8.6% met definition SI. 7.7% achieved at baseline. After stepwise addition ezetimibe acid, 22.6 52.0% target, respectively. median 80 62 mg/dL, corresponding reductions from baseline were 20.0 38.0%, A higher proportion classified as risk compared those (58.1 vs. 49.9%). In conclusion, increased meeting EMR, combination acid has potential substantially increase achieving clinically relevant reductions.

Language: Английский

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Statins Ticagrelor and Rhabdomyolysis: A Coincidence or a Drug Interaction?

Journal of Lipid and Atherosclerosis, Journal Year: 2024, Volume and Issue: 13(1), P. 61 - 61

Published: Jan. 1, 2024

Statins play a key role in the management of atherosclerotic cardiovascular disease for both primary and secondary prevention. However, their increasing usage has correspondingly led to higher incidence adverse effects, with muscle symptoms being most common. An intriguing drug interaction exists between ticagrelor high-intensity statins, which may exacerbate effects statin-induced rhabdomyolysis, leading significant consequences. This study was conducted examine profile patients who have experienced rhabdomyolysis while undergoing percutaneous transluminal coronary angioplasty (PTCA).

Language: Английский

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Recent advances in the management and implementation of care for familial hypercholesterolaemia

Pharmacological Research, Journal Year: 2023, Volume and Issue: 194, P. 106857 - 106857

Published: July 17, 2023

Familial hypercholesterolaemia (FH) is a common autosomal semi-dominant and highly penetrant disorder of the low-density lipoprotein (LDL) receptor pathway, characterised by lifelong elevated levels cholesterol (LDL-C) increased risk atherosclerotic cardiovascular disease (ASCVD). However, many patients with FH are not diagnosed do attain recommended LDL-C goals despite maximally tolerated doses potent statin ezetimibe. Over past decade, several cholesterol-lowering therapies such as those targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) or angiopoietin-like 3 (ANGPTL3) monoclonal antibody ribonucleic acid (RNA) approaches have been developed that promise to close treatment gap. The availability new complementary modes action lipid metabolism has enabled guideline-recommended goals. Emerging for include liver-directed gene transfer LDLR, vaccines key proteins involved in metabolism, CRISPR-based editing PCSK9 ANGPTL3, but further clinical trials required. In this review, current emerging strategies lowering LDL-C, ASCVD risk-stratification, well implementation care reviewed.

Language: Английский

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Lipid-lowering approaches to manage statin-intolerant patients

European Heart Journal Supplements, Journal Year: 2024, Volume and Issue: 26(Supplement_1), P. i56 - i59

Published: April 1, 2024

Abstract Statins have improved the potential to prevent cardiovascular disease events and prolong lives of patients. Statins, among most widely used drugs worldwide, reduce levels low-density lipoprotein cholesterol (LDL-C) by an average 30–50%. However, non-adherence statin therapy, due intolerance, might be as high 60% after 24 months treatment is associated with a 70% increase in risk events. Statin intolerance can classified complete inability tolerate any dose or partial necessary achieve patient-specific therapeutic objective. Reasons for discontinuation are many, statin-associated muscle symptoms being cited frequent reason stopping therapy incidence increasing intensity. Considering causal effect LDL-C atherosclerotic process, clinicians should consider that regardless lipid-lowering patients willing take, reduction they will afford them some benefit reducing risk. Besides statins, current armamentarium offers different strategies reach targets statin-intolerant (i.e. fixed combination between lower plus ezetimibe, bempedoic acid, proprotein convertase subtilisin/kexin type 9 inhibition).

Language: Английский

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Overcoming patient reluctance to statin intolerance

Kardiologia Polska, Journal Year: 2024, Volume and Issue: 82(5), P. 485 - 491

Published: May 8, 2024

Statin therapy is a cornerstone in the management of dyslipidemia, both primary and secondary prevention cardiovascular events. Despite strong guidelines supporting statin use, concerns regarding side effects, particularly musculoskeletal symptoms, contribute to intolerance patient reluctance. While reported 5% 30% patients, its true prevalence may be overestimated due influence nocebo effect. Factors associated with higher incidence include older age, female sex, comorbidities such as diabetes chronic kidney disease, concurrent use medications antiarrhythmic agents or calcium channel blockers. Clinical characterization requires thorough evaluation exclusion alternative causes symptoms. Strategies address reassessing risk, engaging shared decision-making, rechallenge after appropriate washout periods, dosage titration for tolerability, consideration therapies when low-density lipoprotein goals cannot achieved statins. This review provides an overview spectrum intolerance, clinical assessment, systematic approach caring intolerance.

Language: Английский

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