Importancia de la medicina traslacional: mecanismos del beneficio del tratamiento de las dislipemias y su implicación en la reducción de la placa

Abstract

Cardiovascular disease continues to be the most common cause of morbidity and mortality in western countries. Hyperlipidaemia, including hypercholesterolemia and atherogenic dyslipidaemia, is one the main risk factors for atherosclerotic heart disease. Routine therapies for hypercholesterolaemia include HMG-CoA reductase inhibitors (statins), NPC1L1 inhibitors (ezetimibe), phytosterols, menacholyne K, bile salt sequestrants and PCSK9 inhibitors. New drugs under development are CEPT inhibitors, antisense oligonucleotides and inhibitors of microsomal triglyceride transfer protein. The association between hyperlipidaemia and atherosclerosis is well documented. Arterial wall remodelling, described by Glagov more than 3 decades ago, is a key phenomenon in coronary artery atherosclerosis. When atherosclerotic plaque increases, artery diameter also increases to compensate lumen reduction. It is only in the final stage of the process, when the increase in diameter is unable to compensate for plaque growth, that clinical ischaemia develops. In this article, we review the mechanisms of action of drugs used for the treatment of dyslipidaemia, and the role of lipid level control in plaque reversal.