MANAGEMENT OF PATIENTS WITH DYSLIPIDEMIA IN THE PRACTICE OF FAMILY MEDICINE
Dyslipidemia is an important problem for family doctors, as it is a risk factor for the development of atherosclerotic cardiovascular diseases (ACVD). ACVD is the cause of more than 4 million deaths in Europe today. Women in this sad statistic are 2.2 million, and men - 1.8 million. It is expected, that mortality due to cardiovascular diseases in men aged up to 65 years is significantly higher than in women (430 thousand and 193 thousand, respectively).
The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) updated guidelines on the management of people with dyslipidemia (DLP) provide specific recommendations that can be used by family doctors in Ukraine in their daily preventive and curative work. The ESC/EAS-2019 (European Society of Cardiology / European Society of Atherosclerosis) and the Ukrainian Society of Atherosclerosis (USA) guidelines emphasize that the cornerstone of the prevention and treatment of ACVD is primarily the detection and correction of DLP. The prevalence of DLP in Ukraine is about 20%.
At the same time, for effective correction of DLP it is important to verify the type of dyslipidemia, isolate genetically determined forms of dyslipidemia (familial hypercholesterolemia), establish cardiovascular risk, select the most effective measures of lifestyle modification and formulate therapeutic goals of prevention / treatment.
In the treatment of DLP apart from lifestyle modification, the drugs of choice are statins in high-intensity doses. Ezetimibe and PCSK-9 inhibitors can be used in addition to statin therapy in case of its ineffectiveness or side effects. It was found, that resistance to statins and their intolerance is the basis for the use of non-statin hypolipidemic drugs (nutraceuticals), among which the most studied are ω-3 PUFA and phytosterols.
The ESC / EAS (2019) guidelines state that consumption of ω-3 PUFAs is associated with a lower risk of death from CVD and stroke. It was noted, that the mechanism of reducing TG levels under the influence of ω-3 PUFA may be related to their ability to interact with PPAR (receptors that activate the proliferation of peroxisomes) and reduce the secretion of apoprotein B. Recent clinical studies confirm the need for high doses of highly purified form of ω-3 PUFA for patients with elevated TG levels, despite treatment with statins.
Another non-statin drug that reduces LDL levels is bempedoic acid. Studies have shown a significant reduction in LDL levels in patients receiving additional bempedoic acid. The effectiveness of bempedoic acid as a monotherapy of DLP is now being studied.
This review presents new data on the effectiveness of the combination of sugar cane extract policosanol with ω-3 PUFA (docosahexaenoic acid 10%). The drug of this composition "Cardioneurin" is present on the pharmaceutical market of Ukraine. Clinical studies have shown, that in case of resistance or intolerance to statins, especially in high doses, a hybrid strategy of lipid-lowering therapy can be used - a combination of low-intensity doses of statins with a combined nutraceutic "Cardioneurin". This treatment reduces the level of atherogenicity by 22%, which gives grounds for its use in the practice of family doctors.
Other forms of policosanol (other than sugar cane), such as those derived from beeswax or wheat germ, do not have an adequate evidence base.
Thus, dyslipidemia is the primary and main factor in the development of ACS, it in most cases occurs long before the emergence of other important risk factors and may even be a prerequisite for their occurrence. Epidemiological evidence suggests, for example, that DLP may in itself be a risk factor for STEMI / NSTEMI and unstable angina.
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