Via practica 6/2014

Combined hypolipidemic therapy in current clinical practice

The epidemiological, human genetic, experimental and clinical intervention studies have shown that increased levels of LDL-cholesterol (LDL-C) are associated with atherosclerosis and increased risk of cardio-cerebrovascular events. The current standards for the prevention of cardio-cerebrovascular diseases emphasize the importance of achieving target levels for LDL-C. Statins have the largest medical evidence and they are the first line treatment in secondary prevention, as well as primary prevention. However, remain in clinical practice for statins some goals unfulfilled. Only a small percentage of high risk patients on the maximum doses of statins or on the maximum tolerated doses of statins, achieved target values for LDL-C. With an increasing number of patients treated with statins we faced with more statins intolerant patients. Another problem is the non adherence to statin treatment and the high residual cardiovascular risk. Using of the combined hypolipidemic therapy can us to help. Today we have the opportunity to add ezetimibe to statins (for further reduction of LDL-C) or fenofibrate (effect on atherogenic dyslipidaemia). Until recently, we had the opportunity to use also a combination of a statin with niacin. The combination of statins with inhibitors of CETP – torcetrapib and dalcetrapib failed. The near future will bring new opportunities – treatment with fully human monoclonal antibodies against PCSK9. The use of combination therapy in our clinical experience is still very low.

Keywords: combined hypolipidemic therapy, ezetimibe, fenofibrate, niacin, CETP inhibitors, human monoclonal antibodies against PCSK9.