Highlights
- •This EAS Task Force gives practical guidance for combination lipid lowering therapy in high- and very-high-risk patients.
- •In patients unlikely to reach the LDL-C goal with a statin alone combination with ezetimibe is suggested as first choice.
- •A PCSK9 inhibitor may be added if LDL-C levels remain high.
- •For type 2 diabetes with high triglycerides on statin, fenofibrate may be considered for macro- and microvascular benefits.
- ••High-dose icosapent ethyl may be also considered for high triglycerides on statin treatment, weighing benefit vs. risk.
Abstract
Background and aims
This European Atherosclerosis Society (EAS) Task Force provides practical guidance
for combination therapy for elevated low-density lipoprotein cholesterol (LDL-C) and/or
triglycerides (TG) in high-risk and very-high-risk patients.
Methods
Evidence-based review.
Results
Statin-ezetimibe combination treatment is the first choice for managing elevated LDL-C
and should be given upfront in very-high-risk patients with high LDL-C unlikely to
reach goal with a statin, and in primary prevention familial hypercholesterolaemia
patients. A proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor may be
added if LDL-C levels remain high. In high and very-high-risk patients with mild to
moderately elevated TG levels (>2.3 and < 5.6 mmol/L [>200 and < 500 mg/dL) on a statin,
treatment with either a fibrate or high-dose omega-3 fatty acids (icosapent ethyl)
may be considered, weighing the benefit versus risks. Combination with fenofibrate
may be considered for both macro- and microvascular benefits in patients with type
2 diabetes mellitus.
Conclusions
This guidance aims to improve real-world use of guideline-recommended combination
lipid modifying treatment.
Keywords
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Article info
Publication history
Published online: April 12, 2021
Accepted:
March 30,
2021
Received:
March 18,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
