Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Weingartnerl, O; Landmesser, U; Marz, W; Katzmann, JL; Laufs, U.
Comments on the guidelines (2019) of the ESC/EAS on the diagnostics and treatment of dyslipidemias.
KARDIOLOGE. 2020;
Doi: 10.1007/s12181-020-00399-9
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- Co-Autor*innen der Med Uni Graz
- März Winfried
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- Abstract:
- The goal of lipid-lowering therapy is to achieve the greatest possible absolute reduction in cardiovascular events. The absolute risk reduction is determined by the individual global vascular risk, the initial level of low-density lipoprotein (LDL-C) and, both the duration and the extent of the achieved LDL-C reduction. The LDL-C targets of the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines are a recommandation of an expert panel to translate evidence-based principles into therapeutic strategies. Guideline authors have to consider issues of practical feasibility to achieve LDL-C targets (but also frustrations when failing to achieve these) and guide all parties involved in terms of a more effective LDL-C lowering. Recently published trails on PCSK9 inhibitors (PCSK9I) demonstrated that there is no lower limit for the relationship between achieved LDL-C serum concentration and cardiovascular risk reduction, i.e. the lower LDL-C, the lower the cardiovascular risk. Moreover - and this is one of the most important findings in recent years - there is no evidence for severe side-effects induced by statins, ezetimibe or PCSK9I. High-intensity statins and ezetimibe are generically available and combination therapy (e.g. IMPROVE-IT) has demonstrated an effective and safe LDL-C reduction in the range of the newly recommended LDL-C targets for very high risk patients (55 & x202f;mg/dl; 1.4 & x202f;mmol/L), which is another reason why these limits were chosen. In the light of the positive PCSK9I studies which included patients at very high cardiovascular risk, the 2019 ESC/EAS guidelines focus primarily on high risk patients. A more detailed analysis of low risk patients, in whom a large proportion of heart attacks occur, is expected in the next revision of these guidelines. A shortcoming in the present guidelines are the incomplete evidence-based nutritional recommendations. Other important new aspects of the revised version of the guidelines which are of practical relevance are a more prominent inclusion of vascular imaging techniques, triglyceride-rich lipoproteins (ApoB, non-HDL targets) and Lp(a).
- Find related publications in this database (Keywords)
- Cholesterol
- Triglycerides
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- Lipid-lowering treatment
- Cardiovascular risk