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Management of dyslipidaemia in patients with comorbidities: facing the challenge
Journal article   Open access   Peer reviewed

Management of dyslipidaemia in patients with comorbidities: facing the challenge

Gert Mayer, Dobromir Dobrev, Juan Carlos Kaski, Anne Grete Semb, Kurt Huber, Andreas Zirlik, Stefan Agewall and Heinz Drexel
European heart journal. Cardiovascular pharmacotherapy, v 10(7), pp 608-613
01 Nov 2024
DOI: https://doi.org/10.1093/ehjcvp/pvae058
PMID: 39153964
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1093/ehjcvp/pvae058View
Published, Version of Record (VoR) Open

Abstract

Biomarkers - blood Cardiovascular Diseases - diagnosis Cardiovascular Diseases - epidemiology Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Dyslipidemias - blood Dyslipidemias - diagnosis Dyslipidemias - drug therapy Dyslipidemias - epidemiology Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypolipidemic Agents - adverse effects Hypolipidemic Agents - therapeutic use Renal Insufficiency, Chronic - complications Renal Insufficiency, Chronic - diagnosis Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - therapy Risk Factors Treatment Outcome Comorbidity
Dyslipidaemia is a common chronic kidney disease (CKD) and contributes to excessively elevated cardiovascular mortality. The pathophysiology is complex and modified by comorbidities like the presence/absence of proteinuria, diabetes mellitus or drug treatment. This paper provides an overview of currently available treatment options. We focused on individuals with CKD and excluded those on renal replacement therapy (haemodialysis, peritoneal dialysis, or kidney transplantation). The use of statins is safe and recommended in most patients, but guidelines vary with respect to low-density lipoprotein (LDL) cholesterol goals. While no dedicated primary or secondary prevention studies are available for pro-protein convertase subtilisin/kexin type 9 inhibitors, secondary analyses of large outcome trials reveal no effect modification on endpoints by the presence of CKD. Similar data have been shown for bempedoic acid, but no definite conclusion can be drawn with respect to efficacy and safety. No outcome trials are available for inclisiran while the cholesterol lowering effects seem to be unaffected by CKD. Finally, the value of fibrates and icosapent ethyl in CKD is unclear. Lipid abnormalities contribute to the massive cardiovascular disease burden in CKD. Lowering of LDL cholesterol with statins (and most likely PCSK9 inhibitors) reduces the event rate and thus statin therapy should be initiated in almost all individuals. Other interventions (bempedoic acid, inclisiran, fibrates, or icosapent ethyl) currently need a case-by-case decision before prescription.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Pharmacology & Pharmacy
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