Lipid-lowering therapy: Guidelines to precision medicine

Clin Chim Acta. 2021 Mar:514:66-73. doi: 10.1016/j.cca.2020.12.019. Epub 2020 Dec 22.

Abstract

Dyslipidemia is correlated with a series of health problems, such as obesity, insulin resistance, and the development of cardiovascular disease (CVD). Currently, accumulating evidence sheds light on the fact that β-hydroxy β-methylglutaryl-CoA reductase inhibitors, named statins, could lower circulating lipid-density lipoprotein cholesterol (LDL-C) and represent a revolution for the prevention of metabolic disorder diseases. In addition, statins remain the cornerstone of LDL-C-lowering treatments, together with ezetimibe and bile acid sequestrants, which are used either in combination with statins or as monotherapies in the case of statin intolerance or side effects. On the other hand, other medicines that reduce circulating LDL-C have also been researched, including inhibitors of protein convertase subtilisin/kexin type 9 (PCSK9). More recently, PCSK9 inhibitors have been approved for the secondary prevention of CVD and for the atherogenic dyslipidemia therapy. Here, we summarize the latest guidelines for the management of dyslipidemia and its relation to CVD, focusing on LDL-C-lowering medicines that are either available in daily clinical practice or under investigation. In addition, we also discuss the "who, when, and how" with respect to treating patients with dyslipidemia according to LDL-C reduction as an individualized clinical precision medicine.

Keywords: Cardiovascular diseases; Clinical precision medicine; Dyslipidemia; Low-density lipoprotein cholesterol; PCSK9 inhibitors; Statins.

Publication types

  • Review

MeSH terms

  • Anticholesteremic Agents* / therapeutic use
  • Cardiovascular Diseases / drug therapy
  • Cardiovascular Diseases / prevention & control
  • Cholesterol, LDL
  • Dyslipidemias / complications
  • Dyslipidemias / drug therapy*
  • Ezetimibe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Precision Medicine
  • Proprotein Convertase 9

Substances

  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • PCSK9 protein, human
  • Proprotein Convertase 9
  • Ezetimibe