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REVIEW ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 4  |  Page : 18-25

Treatment of Hyperlipidemia: Consensus and Controversies


1 Department of Medicine I, Academic Teaching Hospital Feldkirch; Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Division of Angiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
2 Private University of the Principality of , Triesen, Liechtenstein
3 Department of Medicine I, Academic Teaching Hospital Feldkirch; Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Division of Angiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland; Drexel University College of Medicine, Philadelphia, PA, USA

Correspondence Address:
Dr. Christoph H Saely
Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cp.cp_4_17

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Based on epidemiological, genetic, and clinical trial data, there is a consensus now that low-density lipoproteins (LDL) cholesterol causes atherosclerosis and that lowering LDL cholesterol reduces the risk of atherosclerotic cardiovascular disease. Current guidelines on lipid management, therefore, focus on LDL cholesterol. The absolute benefit derived from lowering LDL cholesterol is greatest with the highest baseline risk; the most intensive treatment, therefore, is appropriate in the patients at the highest risk. Regarding the choice of drugs, statins are the basis of lipid management; if treatment goals are not met with statins alone, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors can be added to further reduce cardiovascular risk. Several questions remain open to debate. For example, the long-term net benefit of statin treatment in young patients with a low 10-year, but a high lifetime risk of cardiovascular events has not been demonstrated; in the absence of robust data, also lipid management in very old patients remains a question of clinical judgment. Further, given the evidence from clinical trials for further risk reduction with lowering LDL cholesterol below currently recommended targets, there is no universal consent on how low to go with LDL cholesterol. Also, with the availability of potent but expensive treatment options, the cost-effectiveness of lipid management remains a field of controversy. Finally, new lipid drugs are under development that yet has to prove their role in lipid management.


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