Statement from a European Atherosclerosis Society Task Force
Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force
2021 Apr 13;S0021-9150(21)00162-3. doi: 10.1016/j.atherosclerosis.2021.03.039. Online ahead of print.
Maurizio Averna 1,Maciej Banach 2,Eric Bruckert 3,Heinz Drexel 4,Michel Farnier 5,Dan Gaita 6,Paolo Magni 7,Winfried März 8,Luis Masana 9,Alberto Mello E Silva 10,Zeljko Reiner 11,Emilio Ros 12,Michal Vrablik 13,Alberto Zambon 14,Jose L Zamorano 15,Jane K Stock 16,Lale S Tokgözoglu 17,Alberico L Catapano 18
Affiliations
1 Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities, University of Palermo, Palermo, Italy.
2 Polish Mother's Memorial Hospital Research Institute (PMMHRI) in Lodz, Lodz, Poland.
3 Pitié-Salpêtrière Hospital and Sorbonne University, Cardio Metabolic Institute, Paris, France.
4 Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA.
5 PEC2, EA 7460, University of Bourgogne Franche-Comté and Department of Cardiology, CHU Dijon-Bourgogne, Dijon, France.
6 Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Clinica de Recuperare Cardiovasculara, Timisoara, Romania.
7 Department of Pharmacological and Biomolecular Sciences, Universita' degli Studi di Milano, Milan, and IRCCS MultiMedica, Milan, Italy.
8 SYNLAB Academy, SYNLAB Holding Deutschland GmbH, and Medical Clinic V, Medical Faculty of Mannheim, University of Heidelberg, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria.
9 Vascular Medicine and Metabolism Unit, Research Unit on Lipids and Atherosclerosis, Sant Joan University Hospital, Universitat Rovira i Virgili, IISPV CIBERDEM, 43201, Reus, Spain.
10 Luz Saúde-Portugal; Sociedade Portuguesa de Aterosclerose, Lisbon, Portugal.
11 Department of Internal Diseases University Hospital Center Zagreb, School of Medicine, Zagreb University, Zagreb, Croatia.
12 Lipid Clinic, Endocrinology and Nutrition Service, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, 08036, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, 28029, Spain.
13 Third Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, U Nemocnice 1, 128 08, Prague 2, Czech Republic.
14 Department of Medicine - DIMED, University of Padua, Padova, and IRCCS MultiMedica, Milan, Italy.
15 Department of Cardiology, University Hospital Ramón y Cajal Carretera de Colmenar, Madrid, Spain.
16 European Atherosclerosis Society, Mässans Gata 10, SE-412 51, Gothenburg, Sweden.
17 Department of Cardiology, Hacettepe University Faculty of Medicine, Turkey.
18 Department of Pharmacological and Biomolecular Sciences, Universita' degli Studi di Milano, Milan, and IRCCS MultiMedica, Milan, Italy.
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 high-risk 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.
