Jornal Médico – Antidyslipidemic treatment with new levels of LDL cholesterol

He has been invited to take part as a speaker in “Module 2: A New Perspective on the Treatment of Coronary Medicine in 2022” of the Update Cycle of the Portuguese Congress of Cardiology 2022, Ricardo Fontes-Carvalho, head of the Department of Cardiology at Centro Hospitalar de Vila Nova de Gaia / Espinho, discussed the importance of improving LDL cholesterol and the role of various dyslipidemic drugs in patients at high risk of heart disease.

“Today, there is strong evidence of a relationship that contributes to the rise of LDL cholesterol and the development of atherosulinosis, combined with meta-analysis and Mendelian randomization studies” began by modifying Ricardo Fontes-Carvalho, blocking how these have already been established. in international guidelines.

With regard to the management of dyslipidemia, the 2019 guidelines of the European Society of Cardiology (ESC) “mean that LDL cholesterol is an excellent target for treatment and treatment”, said a spokesman and reviewer. As a result of the evidence, “the guidelines began to promote lower LDL cholesterol levels, based on the increased risk of heart disease in the respondent,” he said.

However, Ricardo Fontes-Carvalho cautioned against “differences in the available evidence from clinical trials and guidelines and the use of this information in clinical practice”, leading the expert to refer to dyslipidemia as “poor relative prevention of heart disease”. Instead, he explained, “in contrast to high blood pressure and diabetes, only 3 percent of high-risk patients and 7 percent of high-risk patients, therefore, have their level of of LDL cholesterol, according to a recent study. LATINO, held in Portugal ”.

As Ricardo Fontes-Carvalho explained of these statistics, “despite the effective treatment and high risk of cardiovascular risk, a large proportion of the people who studied were treated with very low doses”.

To monitor the management of dyslipidemia, clinical discussions were followed, with the following cohorts being identified as cardiovascular risk factors: high blood pressure, type II diabetes, smoking and dyslipidemia, history of ischemic stroke and acute myocardial infarction. The lipid profile given for approval was as follows:

  • Total cholesterol = 260 mg / dl,
  • HDL cholesterol = 35 mg / dl
  • LDL cholesterol = 199 mg / dl
  • Cholesterol free HDL = 225 mg / dl

Along with the participation of the audience, it was confirmed that the legal support for the release was a combination of very strong statin and ezetimibe. “However,” he said, “to achieve your LDL-cholesterol (<55mg / dl) and 87% reduction in risk of heart disease, a complete reduction of 144 mg / dl would be possible. Depending on the starting price."

Ricardo Fontes-Carvalho warned, in this regard, that “while the guidelines encourage the introduction of effective statin therapy, after addressing the target LDL-cholesterol target, it also recommends starting a drug that allows up to a certain amount of LDL cholesterol.”

Therefore, at present, the combination of atorvastatin 40 mg with ezetimibe was selected, which, after eight weeks of treatment, was able to reduce cholesterol levels as follows:

  • Total cholesterol = 176 mg / dl
  • HDL cholesterol = 39 mg / dl
  • LDL cholesterol = 118 mg / dl
  • Cholesterol free HDL = 137 mg / dl

“As it turned out,” said a cardiologist, “despite the dramatic reduction in LDL cholesterol, it was not possible to reach the recommended price, allowing the patient to receive treatment with PCSK9 inhibitors.

In this regard, Ricardo Fontes-Carvalho cited “Practical support for the use of PCSK9 inhibitors in Portugal”, which came from the Portuguese Society of Cardiology, Portuguese Society of Atherosclerosis, Portuguese Society of Internal Medicine and Portuguese Society of Endocrinology, Diabetes and Metabolism.

Considering the future, a new anti-dyslipidemic drug has also been briefly responded to, emphasizing “bempedoic acid 180 mg, which, instead of statins, acts on ATP citrate lyase and inclisiran, inhibiting the degradation of LDL cholesterol receptors. can significantly reduce LDL cholesterol (40-50%) with only two injections a year ”.

Finally, Ricardo Fontes-Carvalho promoted the idea of ​​”low, fast and long, good” when it comes to LDL cholesterol and the idea, “more important than reducing fat loss and reducing risk.” cardiovascular disease, developing and refining patient care systems “.

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