Modern strategies for lipid-lowering therapy in patients with ischaemic heart failure and concomitant metabolic pathology

Given the increasing prevalence of cardiovascular diseases and their complications, the study of effective approaches to lipid-lowering therapy, especially in patients with comorbid conditions, is a highly relevant task in modern cardiology. The aim of this study was to analyse modern therapeutic strategies for lowering low-density lipoprotein cholesterol (LDL-C) in patients with chronic heart failure (CHF) due to ischaemic heart disease (IHD), with concomitant obesity and type 2 diabetes mellitus. We also evaluated their effectiveness and safety, taking into account the latest clinical data. The study included 225 patients with ischaemic CHF, who were divided into four groups according to the presence of metabolic disorders. The effectiveness of lipid-lowering therapy with rosuvastatin (20-40 mg) and ezetimibe was assessed. Rosuvastatin monotherapy at a dose of 20 mg enabled only partial achievement of target LDL-C levels (< 1.4 mmol/L): these were reached by 44% of patients in the first group, 56% in the second, 58% in the third, and 66% in the fourth. Some patients independently discontinued the medication. Further escalation of therapy (increasing the dose of rosuvastatin or adding ezetimibe) significantly improved lipid profile parameters. Combined therapy with rosuvastatin 20 mg and ezetimibe 10 mg proved to be highly effective in patients at extreme risk, allowing them to achieve target LDL-C levels (< 1.0 mmol/L) in 95.5% of cases. Achieving target low-density lipoprotein cholesterol levels in patients with chronic heart failure and ischaemic heart disease, especially in the presence of concomitant type 2 diabetes mellitus and obesity, is a complex task. Statin monotherapy is often insufficiently effective, which requires the use of combined hypolipidaemic therapy. The value of this work lies in confirming the need for an individualised approach to the treatment of dyslipidaemia and the importance of increasing patient adherence to the prescribed therapy to achieve optimal results