Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force

Identifier:  imarina:9216835

Handle: https://hdl.handle.net/20.500.11797/imarina9216835

Authors:  Averna, Maurizio; Banach, Maciej; Bruckert, Eric; Drexel, Heinz; Farnier, Michel; Gaita, Dan; Magni, Paolo; Maerz, Winfried; Masana, Luis; Mello e Silva, Alberto; Reiner, Zeljko; Ros, Emilio; Vrablik, Michal; Zambon, Alberto; Zamorano, Jose L; Stock, Jane K; Tokgozoglu, Lale S; Catapano, Alberico L

Abstract:
Background and aims: This European Atherosclerosis Society (EAS) Task Force provides practical guidance for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) in highrisk and very-high-risk patients. Methods: Evidence-based review. Results: Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C and should be given upfront in very-high-risk patients with high LDL-C unlikely to reach goal with a statin, and in primary prevention familial hypercholesterolaemia patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be added if LDL-C levels remain high. In high and very-high-risk patients with mild to moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin, treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl) may be considered, weighing the benefit versus risks. Combination with fenofibrate may be considered for both macro- and microvascular benefits in patients with type 2 diabetes mellitus. Conclusions: This guidance aims to improve real-world use of guideline-recommended combination lipid modifying treatment.