[What is proven in the treatment of lipid disorders?]

Abstract

Cardiovascular diseases are still the leading global cause of mortality. Modifiable cardiovascular risk factors have been well-defined for many years and are amenable to multimodal treatment. The scope of pharmaceutical interventions targeting atherogenic lipoproteins in general and low-density lipoprotein (LDL)-cholesterol concentrations in particular, has significantly broadened over the last years, leading to an intensification of appropriate treatment targets, which are not sufficiently achieved in the clinical routine. Current prevention guidelines issued by the European Society for Cardiology (ESC) define patient cohorts according to their individual cardiovascular risk, which results in a risk-adapted lipid-lowering treatment. The aim is to avoid overtreatment of patients with a low or moderate risk and undertreatment of patients with a high or very high risk. In addition to secondary prevention in patients with an already established cardiovascular disease, primary prevention uses age-adapted risk stratification algorithms to assess the 10-year risk, e.g., systematic coronary risk evaluation 2 (SCORE2), SCORE2-older persons (SCORE2-OP) and the lifetime risk, e.g., lifetime-perspective cardiovascular disease model (LIFE-CVD) as the foundation for therapeutic decision making. Special patient groups with known elevated cardiovascular risk (familial hypercholesterolemia, diabetes mellitus, chronic kidney disease) are stratified by incorporating disease-specific parameters and are treated according to defined lipid-lowering targets.