2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP)

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's 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 recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

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Journal
Drugs
Published
2024-11-04
DOI
https://doi.org/10.1007/s40265-024-02105-5
Citations
39
Primary Topic
Lipoproteins and Cardiovascular Health
Type
article
Field-Weighted Citation Impact
22.34
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article

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP)

Žaneta Petrulionienė, Gani Bajraktari, Azra Durak-Nalbantić, Stanisław Surma et al.
39 citations
Drugs
Lipoproteins and Cardiovascular Health
22.34
article

2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP)

Žaneta Petrulionienė, Gani Bajraktari, Azra Durak-Nalbantić, Stanisław Surma, Ivan Pećin, Ján Fedačko, Dragoş Vinereanu, Matjaž Bunc, Roman Margoczy, R Češka, Eduard Margetić, Olena Mitchenko, Krzysztof Dyrbuś, Charalambos Vlachopoulos, Dan Gaiță, Dariusz Dudek, Agata Bielecka‐Dąbrowa, Peter E. Penson, Piotr Jankowski, Arman Postadzhiyan, Maciej Banach, Francesco Paneni, Marek Gierlotka, Niki Katsiki, Duško Vulić, Zlatko Fras, Ioanna Gouni‐Berthold, György Paragh, Arrigo F.G. Cicero, Gustavs Latkovskis, Robert Gil, Petr Ošťádal, Jacek Jerzy Jozwiak, Anca Pantea Stoian, Ibadete Bytyçi, Zoltán Járai, Michal Vráblík, Željko Reiner, Matias Trbušić, Daniel Pella, Cristian Alexandru Udroiu, Stefania Magda, Margus Viigimaa, Dov Gavish
article en
39 citations

Abstract

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's 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 recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.

DrugsVol. 84(12)
Semmelweis University (HU), University of Sarajevo (BA), Tallinn University of Technology (EE), Jagiellonian University (PL), University of Debrecen (HU), University Hospital Centre Zagreb (HR), Johns Hopkins University (US), University of Ljubljana (SI), Carol Davila University of Medicine and Pharmacy (RO), Medical University of Silesia (PL), University of Opole (PL), Vilnius University (LT), University of Banja Luka (BA), University of Cologne (DE), University of Zagreb (HR), International Hellenic University (GR), National and Kapodistrian University of Athens (GR), European University Cyprus (CY), University of Pavol Jozef Šafárik (SK), Charles University (CZ), Clinical Emergency Hospital Bucharest (RO), Johns Hopkins Medicine (US), Ljubljana University Medical Centre (SI), Shaare Zedek Medical Center (IL), Medical University of Sofia (BG), University Clinical Center of Kosovo (XK), Victor Babeș University of Medicine and Pharmacy Timișoara (RO), North Estonia Medical Centre (EE), University Hospital in Motol (CZ), Pauls Stradiņš Clinical University Hospital (LV), University Hospital of Zurich (CH), Institutul National Victor Babes (RO), Medical University of Lodz (PL), Public Health Institute of the Republic of Srpska (BA), Postgraduate School of Molecular Medicine (PL), University Hospital Hradec Králové (CZ), Polish Mother’s Memorial Hospital Research Institute (PL), University Hospital Cologne (DE), University clinical center of Republika Srpska (BA), Vilnius University Hospital Santariskiu Klinikos (LT), Liverpool John Moores University (GB), University of Prishtina (XK), University of Latvia (LV), University of Bologna (IT)
Good health and well-being
Openalex Percentile: Top 0%
Lipoproteins and Cardiovascular Health
22.34
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