Current pharmacotherapeutic options for primary dyslipidemia in adults

ABSTRACT

Introduction: Atherosclerotic cardiovascular disease (ASCVD) and its clinical manifestations, remain a leading cause of death and disability worldwide. One of the major risk factors of ASCVD is dyslipidemia and all the available guidelines suggest the importance of strategies for lipid control in a remarkable proportion of the general population.

Areas covered: This review focuses on the therapeutic options available for the management of lipid disorders in adults.

Expert opinion: A large body of evidence supports that statins are still the first-line option for the management of hypercholesterolemia in a large percentage of patients. Statins should be given at the appropriate dose and considering the differences in lipid-lowering potency across the different medications. The main current challenge in the treatment of lipid disorders is the need of improving patient adherence and persistence to lipid-lowering treatments beyond the drug choice and the target lipid component. To achieve this goal, the best strategy would be to treat the patients by using the appropriate drugs given at adequate doses to reach the treatment target. We should also avoid drug interactions, monitor possible untoward side effects and promote adherence to treatment by tailoring treatment strategies to each patient.

KEYWORDS:

• Dyslipidaemia
• cardiovascular disease risk
• lipid-lowering drugs
• LDL-Cholesterol
• triglycerides

Article highlights

• Dyslipidemia is largely prevalent in the adult populations and often requires pharmacological treatment.

• Dyslipidemia includes a range of abnormalities of lipid metabolism and may involve a combination of increased total cholesterol, low-density lipoprotein cholesterol, serum triglyceride, and lipoprotein(a) levels or a decrease in high-density lipoprotein cholesterol.

• The lipid-lowering drugs with proven efficacy for lipids control and cardiovascular risk reduction are statins, used as monotherapy or in combination with ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, fibrates, and PUFA.

• Statins reduce the synthesis of cholesterol by the liver, mainly by competitive inhibition with the activity of the HMG-CoA reductase, the rate-limiting enzyme responsible for the transformation of mevalonate into cholesterol.

• Lipid-lowering therapies are associated with an insufficient patient’s compliance and persistence in treatment that can explain the unsatisfactory rate of attainment of desired LDL-Cholesterol and triglycerides levels.

This box summarizes the key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One Referee is an employee of National Clinical Research, Inc. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This manuscript was not funded.