Maurizio Averna1, Maciej Banach2, Eric Bruckert3, Heinz Drexel4, Michel Farnier5, Dan Gaita6, Paolo Magni7, Winfried März8, Luis Masana9, Alberto Mello E Silva10, Zeljko Reiner11, Emilio Ros12, Michal Vrablik13, Alberto Zambon14, Jose L Zamorano15, Jane K Stock16, Lale S Tokgözoğlu17, Alberico L Catapano18. 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. Electronic address: alberico.catapano@unimi.it.
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.
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.
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