Management of dyslipidaemias in specific patient groups

Czech version

Authors: M. Vaclová; M. Vráblík; R. Češka
Authors‘ workplace: III. interní klinika 1. LF UK a VFN v Praze
Published in: Kardiol Rev Int Med 2017, 19(3): 157-160

Overview

This article focuses on different approaches to the management of dyslipidaemia in selected patient groups. These groups are defined by comorbidities (e. g. acute coronary syndrome, elective coronary intervention, systemic inflammatory diseases, chronic kidney disease, diabetes) or by age and gender. In post-ACS patients, individual studies as well as their meta-analyses support routine, early, intensive and long-term use of statin therapy. Highly effective statins (atorvastatin, rosuvastatin) should be used and the therapy should be initiated no later than 4 days after the event. In patients undergoing percutaneous coronary intervention, high-intensity statin therapy has been shown to be beneficial both in statin-naive patients and in statin users who had the dose up titrated prior to the procedure. Statins reduce the risk of periprocedural myocardial infarction as well as complications during the following 30-day period. Statins reduce the activity of systemic inflammatory diseases and the risk of CVD morbidity and mortality in these patients (particularly in primary prevention). On the contrary, statin cessation leads to increased CVD mortality and morbidity. Declining glomerular filtration associates with increasing cardiovascular risk independently on other risk factors. CKD 3 and 4 lead to a 2- and 3-fold increase of CV mortality, respectively. Thus, patients with CKD 3 are classified as high and those with CKD 4 and 5 as very high risk patients. HIV positive patients have an increased CVD risk compared to HIV negative population. Some antiretroviral drugs more than double the risk. Antiretrovirals can accelerate the development of coronary artery disease particularly in young male smokers with dyslipidaemia. Lipid metabolism disorders in post-transplant patients lead to arterial vasculopathy and atherosclerosis progression. Immunosuppressive treatment has a significant negative impact on lipid metabolism. Lipid lowering efficacy in the elderly in secondary prevention differed according to study and the results are often inconsistent.

Keywords:
dyslipidaemia – acute coronary syndrome – percutaneous coronary intervention – autoimmune diseases – chronic kidney disease – diabetics – the elderly

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