Low-density lipoprotein (LDL) cholesterol levels should be lowered as much as possible to prevent cardiovascular disease, especially in high- and very high-risk patients. This is one of the main messages of the guidelines of the European Society of Cardiology (ESC) and the European Society for Atherosclerosis (EAS) on dyslipidemia, published online today in the European Heart Journal and on the ESC website.
Cardiovascular disease (CVD) is responsible for more than four million deaths each year in Europe. Obstructed arteries, known as atherosclerotic CVD, are the main disease. The guidelines provide recommendations on how to modify plasma lipid levels through lifestyle and medication to reduce the risk of atherosclerotic CVD.
There is already overwhelming evidence from experimental, epidemiological, genetic and randomized clinical trials that higher LDL cholesterol is a strong cause of heart attack and stroke. Lowering LDL cholesterol reduces the risk, regardless of baseline concentration. This means that in people with a very high risk of heart attack or stroke, lowering LDL cholesterol is effective, even if they have below average baseline levels. "
Prof. Colin Bigen, Chair of the Guidance Task Force and Director of the MRS Population Health Research Unit, University of Oxford, UK
There is no lower limit on LDL cholesterol known to be dangerous. to ensure that available medicines (statins, ezetimibe, PCSK9 inhibitors) are used as effectively as possible for lower levels of those most at risk. It is recommended that such patients reach both the target LDL cholesterol level and and a minimum of 50% relative reduction.
"This to ensure that patients at high or very high risk receive intensive LDL cholesterol-lowering therapy, regardless of their baseline, "said Prof. Alberico L. Catapano, Chair of the Target Group for Guidance and Professor of Pharmacology at the Department of Pharmacology and Biomol of Culinary Sciences, University of Milan, Italy. "Patients already close to their current treatment goal will be offered additional treatment, which provides an additional minimum 50% reduction."
"Statins are well tolerated and true 'statin intolerance' is rare. Most patients can take a statin regimen," noted Prof. François Mach, chairman of the target group for guidance and head of the cardiology department at University Hospital Geneva, Switzerland. "Statins have very few side effects. They include an increased risk of diabetes and can rarely cause myopathy. But the benefits of statins far outweigh their risks, even among those with a low risk of atherosclerotic CVD."
However, statins are not recommended for menopausal women considering pregnancy or not using adequate contraception. "Although these drugs have not been shown to cause fetal malformation when used involuntarily in the first trimester of pregnancy, women in need of a statin should avoid them during any period they may conceive, since a formal study has been carried out to address this issue. "
Evidence for statin therapy is more limited in patients over 75 years of age, although still consistent with the benefit. The guidelines advise to consider the level of risk, underlying LDL cholesterol, health and risk of drug interactions when deciding whether statins are appropriate in those over 75 years of age.
Revisions of the risk stratification categories have been made, so that patients with atherosclerotic CVD, target organ-induced diabetes, familial hypercholesterolemia, and severe chronic kidney disease will be categorized as very high-risk (and will therefore be offered treatment. LDL). Treatment goals for a particular risk category apply regardless of whether patients have had a heart attack or stroke.
Evidence since 201
The guidelines recommend a lifelong approach to cardiovascular risk. This means that people of all ages and levels of risk should be encouraged to adopt and maintain a healthy lifestyle. "The essential requirements are a healthy diet, avoiding cigarette smoking and regular exercise," said Professor Mach. "There is no evidence that fish oil supplements prevent first heart attacks and strokes, so we do not recommend them for healthy people."  Source:
European Cardiac Society (ESC)