Korean J Med.  2019 Oct;94(5):396-402. 10.3904/kjm.2019.94.5.396.

Lipid-Lowering Therapy Guidelines

• Lee SH

• KMID: 2462823
• DOI: http://doi.org/10.3904/kjm.2019.94.5.396

Abstract

The major guidelines for lipid-lowering therapy (LLT) have been revised recently. Although "higher cardiovascular risk-aggressive LLT with greater absolute clinical benefit" is the main idea underlying all guidelines, there are some differences in the details among them. The US guidelines recommend pharmacological LLT based on a patient's risk category, independently of their low-density lipoprotein-cholesterol (LDL-C) level. However, the European and Korean guidelines consider the patient's risk category and LDL-C at the same time. Lifestyle modifications are suggested in parallel in all guidelines. The newest US guidelines have characteristically revived target LDL-C values in some patient groups and indications for non-statin drugs (ezetimibe and PCSK9 inhibitors), whereas the European and Korean guidelines have maintained target LDL-C values as usual. It is universally accepted that statins are the first-line agent. Adding ezetimibe, bile acid sequestrants, or PCSK9 inhibitors is recommended as a second line treatment. Appreciating the trend and background of the newest LLT guidelines will be essential to maximize cardiovascular prevention in patients.

Keyword

Cholesterol; Atherosclerosis; Therapeutics; Lipoproteins

MeSH Terms

Atherosclerosis
Bile
Cholesterol
Ezetimibe
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Life Style
Lipoproteins
Cholesterol
Ezetimibe
Lipoproteins