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Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP)
M. Banach, PE. Penson, M. Vrablik, M. Bunc, K. Dyrbus, J. Fedacko, D. Gaita, M. Gierlotka, Z. Jarai, SL. Magda, E. Margetic, R. Margoczy, A. Durak-Nalbantic, P. Ostadal, D. Pella, M. Trbusic, CA. Udroiu, C. Vlachopoulos, D. Vulic, Z. Fras, D....
Jazyk angličtina Země Nizozemsko
Typ dokumentu časopisecké články
- MeSH
- akutní koronární syndrom krev farmakoterapie MeSH
- anticholesteremika škodlivé účinky terapeutické užití MeSH
- ateroskleróza krev farmakoterapie MeSH
- ezetimib škodlivé účinky terapeutické užití MeSH
- lidé MeSH
- lipidy krev MeSH
- management nemoci MeSH
- PCSK9 inhibitory škodlivé účinky terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.
3rd Department of Internal Medicine 1st Faculty of Medicine Charles University Prague Czech Republic
Cardiovascular Center Na Homolce Hospital Prague Czech Republic
Cardiovascular Research Centre University of Zielona Gora Zielona Gora Poland
Department of Cardiology Saint Imre University Teaching Hospital Budapest Hungary
Department of Cardiology University Medical Centre Ljubljana Ljubljana Slovenia
Department of Hypertension Medical University of Lodz Lodz Poland
Faculty of Medicine University of Banja Luka Bosnia and Herzegovina
Faculty of Medicine University of Ljubljana Ljubljana Slovenia
Institute of Cardiology Jagiellonian University Medical College Krakow Poland
Liverpool Centre for Cardiovascular Science Liverpool UK
Maria Cecilia Hospital GVM Care and Research Cotignola Ravenna Italy
Middle Slovak Institute of Cardiovascular Diseases Banska Bystrica Slovakia
Polish Mother's Memorial Hospital Research Institute Lodz Poland
School of Pharmacy and Biomolecular Sciences Liverpool John Moores University Liverpool UK
Citace poskytuje Crossref.org
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- $a Banach, Maciej $u Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Department of Hypertension, Medical University of Lodz (MUL), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland. Electronic address: maciej.banach@iczmp.edu.pl
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- $a Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients.
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