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The changing landscape of lipid-lowering therapy after the new ESC/EAS guidelines for the management of dyslipidaemias: Launching the era of triple hypolipidaemic therapy in very high risk patients

      The recently published ESC/EAS guidelines for the management of dyslipidaemias have lowered the low-density lipoprotein cholesterol (LDL-C) target in the very high risk patients below 55 mg/dL [1.4 mmol/L] [
      • Mach F.
      • Baigent C.
      • Catapano A.L.
      • et al.
      2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk
      ESC committee for practice guidelines (CPG).
      ]. The drug of choice for achieving this target is high-intensity statin to the highest tolerated dose. If the goal is not achieved, the addition of ezetimibe is recommended first, and then the addition of a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i), if LDL-C remains above target. Both non-statins, i.e. ezetimibe and PCSK9i, have been upgraded to class I indication in the therapeutic algorithm of lipid-lowering therapy (LLT) after the positive results of IMPROVE-IT, FOURIER and ODYSSEY OUTCOMES trials [
      • Cannon C.P.
      • Blazing M.A.
      • Giugliano R.P.
      • et al.
      IMPROVE-IT investigators ezetimibe added to statin therapy after acute coronary syndromes.
      ,
      • Sabatine M.S.
      • Giugliano R.P.
      • Keech A.C.
      • et al.
      FOURIER steering committee and investigators. Evolocumab and clinical outcomes in patients with cardiovascular disease.
      ,
      • Schwartz G.G.
      • Steg P.G.
      • Szarek M.
      • et al.
      ODYSSEY OUTCOMES committees and investigators. Alirocumab and cardiovascular outcomes after acute coronary syndrome.
      ].

      Keywords

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