Treatment of dyslipidemia in acute coronary syndrome

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Indian heart journal Pub Date : 2024-03-01 DOI:10.1016/j.ihj.2024.01.011
Satyavir Yadav , Jitendra Pal Singh Sawhney
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Abstract

Despite numerous improvements in the management of acute coronary syndrome(ACS), it is a major cause of mortality in India. Lipids play a critical role in pathogenesis of ACS and reduction of lipid parameters plays a pivotal role in secondary prevention. High total cholesterol and high low-density lipoprotein(LDL) are the major lipid abnormalities globally as well as in Indians. Among all the lipid parameters, LDL is the primary target of lipid-lowering therapies across the globe. High-dose statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and bempedoic acid are recommended therapies for LDL reduction in ACS patients. Statins have pleiotropic effects on the modulation of thrombogenesis, endothelial dysfunction, and myocardial protection. Multiple randomised controlled trials and meta-analyses have shown that the use of high-dose statin has significant benefits in ACS. LDL reduction goal is < 55 mg/dl or at least 50 % reduction from the baseline regardless of age or gender. Non-fasting LDL should be measured soon after the ACS as it varies minimally with food intake. The first line of therapy after ACS is to advise lifestyle modifications, combination therapy including high-dose statin with ezetimibe, and evaluation after 4–6 weeks of the index event. If the goal is not achieved then PCSK 9 inhibitors or Bempedoic acid should be used in combination with statins and ezetimibe to reduce recurrent ischaemic events. Despite the proven effect of these lipid-lowering therapies, undertreatment is still a big hurdle across the globe. Prohibitive costs, adverse effects, medication non-adherence, variation in health practice in different countries, and clinical inertia to prescribe this medication by physicians are the main reasons for the undertreatment.

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急性冠状动脉综合征血脂异常的治疗。
尽管在急性冠状动脉综合征的治疗方面取得了许多进展,但它仍然是印度人死亡的一个主要原因。血脂在 ACS 的发病机制中起着至关重要的作用,降低血脂参数在二级预防中起着关键作用。高总胆固醇和高低密度脂蛋白是全球和印度人的主要血脂异常。在所有血脂参数中,低密度脂蛋白是全球降脂疗法的主要目标。大剂量他汀类药物、依折麦布、PCSK 9 抑制剂和贝贝多克酸是降低 ACS 患者低密度脂蛋白的推荐疗法。他汀类药物在调节血栓形成、内皮功能障碍和心肌保护方面具有多效应。多项临床试验和荟萃分析表明,使用大剂量他汀类药物对 ACS 有显著疗效。降低低密度脂蛋白的目标是
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来源期刊
Indian heart journal
Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
6.70%
发文量
82
审稿时长
52 days
期刊介绍: Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.
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