Approach to patients with residual risk despite statin treatment

摘要

Statins are well established as the first line drug treatment after dietary modification to reduce cardiovascular risk in most patients with lipid disorders. More aggressive therapy with lower targets for low-density lipoprotein cholesterol (LDL-C) has been advocated for high risk patients in recent years. Many patients can reach these targets with intensive statin therapy and for those not reaching the targets with statin alone the addition of bile acid sequestrants or ezetimibe will often facilitate achievement of LDL-C goals. However, these combinations may not correct all the lipid risk factors such as low levels of high-density lipoprotein cholesterol (HDL-C) and high triglycerides. The benefits of treating these lipid disorders are less well established, but the addition of niacin or fibrates such as fenofibrate may be useful in selected subgroups. Lomitapide and mipomersen have been approved for the most severe genetic hyperhpidaemia and other agents in development may prove to have a wider role in lipid treatment depending on the outcome of ongoing studies.