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Vol 11, No 5 (2016)
Review Papers
Published online: 2016-09-23
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Combined drug therapy in heterozygous familial hypercholesterolemia

Longina Kłosiewicz-Latoszek, Barbara Cybulska
DOI: 10.5603/FC.a2016.0093
·
Folia Cardiologica 2016;11(5):401-408.

open access

Vol 11, No 5 (2016)
Review Papers
Published online: 2016-09-23

Abstract

Familial hypercholesterolemia (FH) is characterized by high LDL-cholesterol (LDL-C) plasma concentration that is accompanied by the high risk of premature coronary heart disease (CHD). Heterozygous familial hypercholesterolemia is the most prevalent genetic disease with an estimated prevalence of 1/200–1/500 in general population (in Polish adult population about 1/250). The majority of FH patients are still underdiagnosed and undertreated. Early detection of FH and early initiation of treatment can reduce the cardiovascular risk. High-intensity statin therapy should be the standard of care for FH. Individuals, who cannot achieve the LDL-C target concentration on maximum tolerated dose of a statin or are statin intolerant, may require additional or alternative lipid lowering drugs. In such a situations ezetimibe and/or PCSK9 inhibitors should be considered as additional drugs or as monotherapy. It has been shown that ezetimibe added to statin therapy can reduce additionally the risk of cardiovascular diseases. The recent with PCSK9 inhibitors studies coupled with meta-analyses, show some promise in terms of reducing cardiovascular events and mortality. This article reviews current literature as well as expert opinions on combined drug therapy for FH.

Abstract

Familial hypercholesterolemia (FH) is characterized by high LDL-cholesterol (LDL-C) plasma concentration that is accompanied by the high risk of premature coronary heart disease (CHD). Heterozygous familial hypercholesterolemia is the most prevalent genetic disease with an estimated prevalence of 1/200–1/500 in general population (in Polish adult population about 1/250). The majority of FH patients are still underdiagnosed and undertreated. Early detection of FH and early initiation of treatment can reduce the cardiovascular risk. High-intensity statin therapy should be the standard of care for FH. Individuals, who cannot achieve the LDL-C target concentration on maximum tolerated dose of a statin or are statin intolerant, may require additional or alternative lipid lowering drugs. In such a situations ezetimibe and/or PCSK9 inhibitors should be considered as additional drugs or as monotherapy. It has been shown that ezetimibe added to statin therapy can reduce additionally the risk of cardiovascular diseases. The recent with PCSK9 inhibitors studies coupled with meta-analyses, show some promise in terms of reducing cardiovascular events and mortality. This article reviews current literature as well as expert opinions on combined drug therapy for FH.

Get Citation

Keywords

familial hypercholesterolemia, cardiovascular risk, combined pharmacotherapy, statins, ezetimibe, PCSK9 inhibitors

About this article
Title

Combined drug therapy in heterozygous familial hypercholesterolemia

Journal

Folia Cardiologica

Issue

Vol 11, No 5 (2016)

Pages

401-408

Published online

2016-09-23

DOI

10.5603/FC.a2016.0093

Bibliographic record

Folia Cardiologica 2016;11(5):401-408.

Keywords

familial hypercholesterolemia
cardiovascular risk
combined pharmacotherapy
statins
ezetimibe
PCSK9 inhibitors

Authors

Longina Kłosiewicz-Latoszek
Barbara Cybulska

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