Cardiology
Atherosclerotic Cardiovascular Disease
Cardiovascular disease, of which atherosclerotic cardiovascular disease is the main component, is responsible for more than 4 million deaths per year in Europe1. In Portugal, despite the decreasing trend observed over recent years, cardiovascular disease continues to be the main cause of mortality2.
Hypercholesterolemia, present in more than half of the Portuguese adult population (55.5%), is a major contributor to atherosclerosis and cardiovascular disease2. Specifically, it is now clear that elevated levels of LDL cholesterol (and other apolipoprotein B-rich lipoproteins) are causally related to atherosclerotic cardiovascular disease, and that reducing LDL particles as much as possible reduces cardiovascular events1.
However, despite the recognition of the relationship between dyslipidemia and cardiovascular disease, data show that a significant proportion of patients with dyslipidemia, including those already under some type of antidyslipidemia treatment, are not adequately controlled, that is, without reaching the target LDL cholesterol values defined for the respective cardiovascular risk levelsr2.
In this context, the most recent treatment guidelines have been recommending a treatment strategy that allows reducing LDL cholesterol levels as much as possible (“the lower the better”) – especially in patients with high and very high cardiovascular risk -, which as early as possible (“the sooner the better”) and for as long as possible (“the longer the better”), preferably throughout life3.
References:
1. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk [published correction appears in Eur Heart J. 2020 Nov 21;41(44):4255]. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455.
2. da Silva PM, Aguiar C, Morais J; DISGEN-LIPID study Investigators. Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study. Rev Port Cardiol (Engl Ed). 2019;38(8):559-569. doi:10.1016/j.repc.2019.02.009.
3. Averna M, Banach M, Bruckert E, et al. Practical guidance for combination lipid-modifying therapy in high- and very-high-risk patients: A statement from a European Atherosclerosis Society Task Force.Atherosclerosis. 2021;325:99-109. doi:10.1016/j.atherosclerosis.2021.03.039.
