Volume 8, Issue 6, November 2020, Page: 274-278
Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead
Prabhash Chand Manoria, Department of Cardiology, Manoria Heart & Critical Care Hospital, Bhopal, India
Pankaj Manoria, Department of Cardiology, Manoria Heart & Critical Care Hospital, Bhopal, India
Rajesh Kumar Shrivastava, Divisional Railway Hospital, Bhopal, India
Sharad Kumar Parashar, Central Government Health Scheme, Bhopal, India
Received: Sep. 23, 2020;       Accepted: Oct. 26, 2020;       Published: Nov. 16, 2020
DOI: 10.11648/j.ajim.20200806.16      View  31      Downloads  26
Abstract
Dyslipidemia is the most common modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). There is unequivocal evidence that Low Density Lipoprotein Cholesterol (LDL-C) is the main culprit. Statins, ezetimibe, bempedoic acid and Proprotein Convertase Subtilisin/ Kexin Type 9 (PCSK9) inhibitors are used to target LDL-C. Statin is always utilized as the first line therapy and they decrease LDL-C by approximately 1 mmol/l (40 mg/dL). If the LDL goals are not achieved ezetimibe is used and this decreases LDL-C by 15-20%. Bempedoic acid can also be utilized to lower LDL-C before initiating PCSK9 inhibitors but this is not available in India as yet. PCSK9 inhibitors decrease LDL-C by 1 to 1.5 mmol/l (40-60 mg/dL) on top of all lipid lowering therapy and with this very low LDL-C level targets of < 55 or even < 40 mg/dL can be achieved in very high risk patient. After the LDL-C goal is achieved, non HDL-C is targeted if the triglycerides (TG) levels are above 200 mg/dL. Targeting HDL-C with drugs is not recommended because all trials of HDL-C elevating drugs on top of statins have been negative. The role of TG has a causal factor for ASCVD is still in the process of evolution. Icospent ethyl in REDUCE IT trial has shown reduction in ischemic cardiovascular events in patients with established CVD or diabetics with other risk factors on statins and elevated TG between 135-499 mg/dL. but the mechanism of benefit does not seem to be related to lowering of TG because the benefit was similar in subgroup of patients with TG > 150 <150 mg/dL. Inclisiran which blocks the synthesis of PCSK9 is emerging as very exciting molecule for the future. It decreases LDL-C by 50% which remains there for six months after a single injection of 300 mg.
Keywords
LDL-C Main Culprit of ASCVD, Statins First Drug for Dyslipidemia, Proprotein Convertase Subtilsin-kexin Type 9
To cite this article
Prabhash Chand Manoria, Pankaj Manoria, Rajesh Kumar Shrivastava, Sharad Kumar Parashar, Dyslipidemia and Atherosclerotic Cardiovascular Disease: Flash Back and Vision Ahead, American Journal of Internal Medicine. Special Issue: Dyslipidemia: Flash Back and Vision Ahead. Vol. 8, No. 6, 2020, pp. 274-278. doi: 10.11648/j.ajim.20200806.16
Copyright
Copyright © 2020 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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