Clinical example of successful escalation of lipid-lowering therapy taking into account modern drug capabilities

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The emergence of new classes of modern lipid-lowering drugs in recent years and their availability allow doctors to achieve target of low-density lipoprotein (LDL) levels in patients with very high and extreme cardiovascular risk. This is achieved by correctly assessing the initial cardiovascular risk and timely escalation of lipid-lowering therapy. The demonstrated clinical example shows the logic of the doctor in making decisions on intensifying therapy, searching for possible options for achieving the target LDL level and the result of successfully achieving the goal. The discussion section discusses the issues of therapeutic/medical inertia and the factors that can be influenced to overcome it.

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作者简介

Natalia Korneeva

Far Eastern State Medical University

编辑信件的主要联系方式.
Email: Gladkova1982@mail.ru
ORCID iD: 0000-0001-9878-180X
SPIN 代码: 7817-7670

Dr. Sci. (Med.), Associate Professor, Head of the Department of Faculty and Outpatient Therapy with a Course in Endocrinology

俄罗斯联邦, Khabarovsk

Natalia Mislimova

Sakhalin Regional Clinical Hospital

Email: natalisha1991@mail.ru
ORCID iD: 0009-0001-6842-7735

Cardiologist, Regional Vascular Center of the Department of Cardiology 2

俄罗斯联邦, Yuzhno-Sakhalinsk

参考

  1. Caggiula A.W., Christakis G., Farrand M., et al. The multiple risk factor intervention trial (MRFIT): IV. Intervention on blood lipids. Prevent Med. 1981;10(4):443–75. doi: 10.1016/0091-7435(81)90060-8.
  2. Метельская В.А. Шальнова С.А., Деев А.Д. и др. Анализ распространенности показателей, характеризующих атерогенность спектра липопротеидов, у жителей Российской Федерации (по данным исследования ЭССЕ-РФ). Профилактическая медицина. 2016;19(1):15–23. [Metelskaya V.A., Shalnova S.A., Deev A.D., et al. Analysis of atherogenic dyslipidemias prevalence among population of Russian Federation (results of the ESSE-RF Study). Rus J Prevent Med. 2016;19(1):15 23. (In Russ.)]. doi: 10.17116/profmed201619115-23.
  3. Мешков А.Н., Ершова А.И., Деев А.И. и др. Распределение показателей липидного спектра у мужчин и женщин трудоспособного возраста в Российской Федерации: результаты исследования ЭССЕ-РФ за 2012–2014 гг. Кардиоваскулярная терапия и профилактика. 2017;16(4):62–7. [Meshkov A.N., Ershova A.I., Deev A.D., et al. Distribution of lipid profile values in economically active men and women in Russian Federation: results of the ESSE-RF study for the years 2012-2014. Cardiovascular Ther Prevent. 2016(4):62–7. (In Russ.)]. doi: 10.15829/1728-8800-2017-4-62-67.
  4. Ежов М.В., Кухарчук В.В., Сергиенко И.В. и др. Нарушения липидного обмена. Клинические рекомендации 2023. Российский кардиологический журнал. 2023;28(5):5471. [Ezhov M.V., Kukharchuk V.V., Sergienko I.V., et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Rus J Cardiol. 2023;28(5):5471. (In Russ.)]. doi: 10.15829/1560-4071-2023-5471.
  5. Mach F., Baigent C., Catapano A.L., et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;1;41(1):111–88. doi: 10.1093/eurheartj/ehz455.
  6. 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. N Engl J Med. 2017;4;376(18):1713–22. doi: 10.1056/NEJMoa1615664.
  7. Jukema J.W., Szarek M., Zijlstra L.E., et al. ODYSSEY OUTCOMES Committees and Investigators. Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome: ODYSSEY OUTCOMES Trial. J Am Coll Cardiol. 2019;3;74(9):1167–76. doi: 10.1016/j.jacc.2019.03.013.
  8. Ballantyne C.M., Raichlen J.S., Nicholls S.J., et al. ASTEROID Investigators. Effect of rosuvastatin therapy on coronary artery stenoses assessed by quantitative coronary angiography: a study to evaluate the effect of rosuvastatin on intravascular ultrasound-derived coronary atheroma burden. Circulation. 2008;13;117(19):2458–66. doi: 10.1161/CIRCULATIONAHA.108.773747.
  9. Lazaro P., Murga N., Aguilar D., et al. INERTIA Study Investigators. Therapeutic inertia in the outpatient management of dyslipidemia in patients with ischemic heart disease. The inertia study. Rev Esp Cardiol. 2010;63(12):1428–37. English, Spanish. doi: 10.1016/s1885-5857(10)70277-2.
  10. Banach M., Surma S., Reiner Z., et al. Personalized management of dyslipidemias in patients with diabetes-it is time for a new approach (2022). Cardiovasc Diabetol. 2022;28;21(1):263. doi: 10.1186/s12933-022-01684-5.
  11. Cannon C.P., Blazing M.A., Giugliano R.P., et al. IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;18;372(25):2387–97. doi: 10.1056/NEJMoa1410489.
  12. Schiele F., Perez de Isla L., Arca M., et al. Is it Time for Single-Pill Combinations in Dyslipidemia? Am J Cardiovasc Drugs. 2022;22(3):239–49. doi: 10.1007/s40256-021-00498-2.
  13. Rajtar-Salwa R., Bobrowska B., Socha S., et al. Efficacy of Alirocumab, Evolocumab, and Inclisiran in Patients with Hypercholesterolemia at Increased Cardiovascular Risk. Medicina. 2024;60 (7):1124. doi: 10.3390/medicina60071124.
  14. Kosmas C.E., Munoz Estrella A., Sourlas A., et al. Inclisiran: A New Promising Agent in the Management of Hypercholesterolemia. Diseases. 2018;13;6(3):63. doi: 10.3390/diseases6030063.
  15. Levin A.A. Treating Disease at the RNA Level with Oligonucleotides. N Engl J Med. 2019;3;380(1):57–70. doi: 10.1056/NEJMra1705346.
  16. Wilkinson M.J., Bajaj A., Brousseau M.E., et al. Harnessing RNA Interference for Cholesterol Lowering: The Bench-to-Bedside Story of Inclisiran. J Am Heart Assoc. 2024;13(6):e032031. doi: 10.1161/JAHA.123.032031.
  17. Wang N., Tall A.R. A New Approach to PCSK9 Therapeutics. Circ Res. 2017;31;120(7):1063–5. doi: 10.1161/CIRCRESAHA.117.310610.
  18. Giugliano R.P., Pedersen T.R., Park J.G., et al. FOURIER Investigators. Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial. Lancet. 2017;28;390(10106):1962–71. doi: 10.1016/S0140-6736(17)32290-0.
  19. Wang X., Wen D., Chen Y., et al. PCSK9 inhibitors for secondary prevention in patients with cardiovascular diseases: a bayesian network meta-analysis. Cardiovasc Diabetol. 2022;15;21(1):107. doi: 10.1186/s12933-022-01542-4.
  20. Ray K.K., Wright R.S., Kallend D., et al. ORION-10 and ORION-11 Investigators. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;16;382(16):1507–19. doi: 10.1056/NEJMoa1912387.
  21. Raal F.J., Kallend D., Ray K.K., et al. ORION-9 Investigators. Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia. N Engl J Med. 2020;16;382(16):1520–30. doi: 10.1056/NEJMoa1913805.
  22. Li H., Zhao S., Wu J., et al. Estimating the effect of inclisiran on hypercholesterolemia and primary prevention of cardiovascular disease: the NHANES 1999-2018 study. Lipids Health Dis. 2024;23(1):313. doi: 10.1186/s12944-024-02294-8.
  23. Atia A., Aboeldahab H., Wageeh A., et al. Safety and Efficacy of Proprotein Convertase Subtilisin-Kexin Type 9 Inhibitors After Acute Coronary Syndrome: A Meta-analysis of Randomized Controlled Trials. Am J Cardiovasc Drugs. 2024;24(1):83–102. doi: 10.1007/s40256-023-00621-5.
  24. Mohamed F., Mansfield B., Raal F.J. Targeting PCSK9 and Beyond for the Management of Low-Density Lipoprotein Cholesterol. J Clin Med. 2023;2;12(15):5082. doi: 10.3390/jcm12155082.
  25. Phillips L.S., Branch W.T., Cook C.B., et al. Clinical inertia. Ann Intern Med. 2001;6;135(9):825–34. doi: 10.7326/0003-4819-135-9-200111060-00012.
  26. Сапина А.И., Варламова Ю.Ю., Папырина М.Г. и др. Результаты исследования эффективности гиполипидемической терапии с применением инклисирана у пациентов с атеросклеротическими сердечно-сосудистыми заболеваниями в московском здравоохранении. Российский кардиологический журнал. 2024;29(6):5943. [Sapina A.I., Varlamova Yu.Yu., Papyrina M.G., et al. Effectiveness of inclisiran lipid-lowering therapy in patients with atherosclerotic cardiovascular disease in Moscow healthcare. Rus J Cardiol. 2024;29(6):5943. (In Russ.)]. doi: 10.15829/1560-4071-2024-5943.
  27. Lee J., Egolum U., Parihar H., et al. Effect of Ezetimibe Added to HighIntensity Statin Therapy on Low-Density Lipoprotein Cholesterol Levels: A Meta-Analysis. Cardiol Res. 2021;12(2):98–108. doi: 10.14740/cr1224.

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2. Fig. 1. Diagnostic CAG from 05/23/2023

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3. Fig. 2. Balloon vasodilation with the installation of 3 stents in a vessel (RCA, Yukon Chrome PC stents 2.75x40 mm, 2.75x40 and 3.0x18 mm) from 05/23/2023

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4. Fig. 3. Balloon vasodilation with the installation of 2 stents in a vessel (LAD, Yukon Chrome stents 3.0x32 mm and 3.0x24 mm) from 08/10/2023

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5. Fig. 4. CAG control from 07.2024: previously implanted stents are patent without signs of restenosis

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