A Task Force of the European Atherosclerosis Society (EAS) issued a new guidance document on combination lipid-lowering therapy in high or very high risk patients, which aims to offer a practical way to implement the 2019 European Society of Cardiology/EAS guidelines for the management of dyslipidemias. It was published on April 12, 2021 in Atherosclerosis, and more recently, the lead author Alberico L. Catapano, MD, PhD, discussed this new guidance at the recent EAS 2021 Virtual Congress.
As for the key highlights of new document, most noteworthy is the recommendation to prescribe a combination of statins with ezetimibe to patients with a low baseline probability of achieving their LDL cholesterol targets on statin monotherapy as first choice, without prior attempts to use a statin alone. In particular, for patients with atherosclerotic CVD, whose LDL goal is <1.4 mmol/L, the co-administration of a high-intensity statin and ezetimibe is suggested already at LDL cholesterol levels ≥ 2.6 mmol/L. After that, a PCSK9 inhibitor may be added if LDL-C levels remain high.
The new document also includes a large section on elevated triglyceride levels despite statin treatment. In such cases, fenofibrate and high doses of icosapent ethyl may be considered, provided that the expected benefits outweigh the risks.
Finally, the paper discusses current data on nutraceuticals such as plant sterols or stanols, red yeast rice, and whole foods such as nuts, pulses, oat cereal.
Reference: https://www.atherosclerosis-journal.com/article/S0021-9150(21)00162-3/fulltext
