Best Treatment Strategies With Statins to Maximize the Cardiometabolic Benefits

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  • Cho Kyoung Im
    Department of Cardiology, Kosin University Gospel Hospital
  • Sakuma Ichiro
    Cardiovascular Medicine, Hokko Memorial Clinic Health Science University of Hokkaido
  • Sohn Il Suk
    Department of Cardiology, Cardiovascular Center, Kyung Hee University Hospital at Gangdong
  • Hayashi Toshio
    Department of Geriatrics, Nagoya University Graduate School of Medicine
  • Shimada Kazunori
    Cardiovascular Medicine, Juntendo University Graduate School of Medicine
  • Koh Kwang Kon
    Department of Cardiology, Gachon University Gil Medical Center Gachon Cardiovascular Research Institute

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Abstract

<p>Statins are important for preventing adverse cardiovascular events in patients with both high and low risk of vascular disease, by reducing the levels of low-density lipoprotein cholesterol (LDL-C). However, statins dose-dependently increase adverse effects and increase the risk of type 2 diabetes. Previously, it was hypothesized this was caused by to off-target effects, but recent studies demonstrate it is caused by on-target effects. Nonetheless, the American guidelines recommend the use of high-intensity statin therapy, and extend its use to most people at risk of vascular diseases, particularly older people. In contrast, European, Korean, and Japanese committees have expressed concerns about the potential adverse effects of using high-intensity statins for lifelong periods in a large fraction of the population. Patients who have achieved LDL-C levels below currently recommended targets may still experience cardiovascular events, resulting from residual risk. Ezetimibe, PCSK9 inhibitors, inclisiran, and ANGPTL3 antisense oligonucleotides are promising alternative non-statin drugs. Of interest, cross-talk between hypercholesterolemia and the renin-angiotensin-system exists at multiple levels of insulin resistance and endothelial dysfunction. There are still unanswered questions on how to maximize the cardiometabolic benefits of statins in patients. We will discuss the results of randomized clinical trials, meta-analysis, and recent clinicopharmacogenetic studies, and propose practical guidelines to maximize the cardiometabolic benefits while reducing adverse effects and overcoming residual risk.</p>

Journal

  • Circulation Journal

    Circulation Journal 82 (4), 937-943, 2018

    The Japanese Circulation Society

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