Page 28 - GALENIKA MEDICAL JOURNAL

THERAPEUTIC APPROACH IN THE

TREATMENT OF DYSLIPIDEMIA:

NOVELTIES AND CHALLENGES

Katarina Lalić Introduction
1, 2
Nataša Rajković Numerous epidemiological and population studies in
1, 2
Ljiljana Popović recent decades indicate that cardiovascular diseases (CVD)
1, 2
Sandra Singh Lukač represent the leading cause of morbidity and mortality wor-
1, 2
Iva Rasulić ldwide. As much as a third of all causes of mortality at the
1, 2
Ana Petakov global level are the result of CVD . In that regard, significant
2
1
Milica Krstić efforts are being invested in identifying and modulating risk
1
Marija Mitrović 1 factors associated with the onset of CVD, with lipid metabo-
lism disorders being the most common among them . Dysli-
2
1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
pidemia represents a spectrum of lipid metabolism disor-
2 Clinic for endocrinology, diabetes and metabolic diseases, University
Clinical Center of Serbia, Belgrade, Serbia ders characterized by an increase in total cholesterol (TC),
cholesterol contained in low-density lipoproteins (LDL), and
triglycerides (TG), as well as a decrease in cholesterol con-
Corresponding author:
tained in high-density lipoproteins (HDL), or a combination
Prof. dr Katarina Lalić of these disorders . According to research in the adult po-
3
pulation in the United States, over 30% of individuals have
Medicinski fakultet Univerziteta u Beogradu, Klinika za
endokrinologiju, dijabetes i bolesti metabolizma, Univerzitetski elevated levels of total and LDL cholesterol, while around
4
klinički centar Srbije, Dr Subotića 13, Beograd, Srbija 20% of the adult population has elevated triglyceride levels .
katarina.s.lalic@gmail.com According to etiology, dyslipidemias can be primary (in-
herited) or secondary. Primary dyslipidemias result from
gene mutations, leading to excessive production or defecti-
ve clearance of lipid fractions 3, 5, 6 . Familial hypercholestero-
Abstract lemia (FH) (homozygous or heterozygous) is an autosomal
dominant inherited disorder characterized by elevated le-
Cardiovascular diseases are the leading cause of vels of total and LDL cholesterol, as well as the development
morbidity and mortality worldwide. Dyslipidemia of premature cardiovascular disease (CVD) 3, 5 . Secondary
is a significant risk factor for the development of dyslipidemias account for more than one-third of all causes
cardiovascular diseases, and lowering the level of serum of dyslipidemias, and they are most commonly associated
lipids leads to a reduction in cardiovascular morbidity with diabetes, hypothyroidism, obesity, unhealthy diet,
and mortality. The primary therapeutic target is LDL- nephrotic syndrome, chronic kidney disease, liver diseases,
cholesterol (c). Statin therapy is often not sufficient to excessive alcohol consumption, other endocrine disorders,
achieve LDL-c target values, so it is necessary to combine as well as medications such as thiazides, beta-blockers, glu-
. Ac-
cocorticoids, estrogen, progesterone, steroids, etc
3, 5-7
them with other lipid-lowering drugs. However, after cording to data from 2019, elevated LDL cholesterol levels
it was noticed that unwanted cardiovascular events accounted for essentially 44% of mortality from ischemic
occurred despite the achieved target values of LDL-c, heart disease and 22% of mortality from ischemic stroke
attention was paid to the residual cardiovascular risk. globally .
6
Therefore, there was the development of new therapeutic
According to the guidelines of the European Atheroscle-
strategies targeting triglyceride-rich lipoproteins, rosis Society/European Society of Cardiology (EAS/ESC) and
lipoprotein (a), and apolipoproteins CIII and B. The results the American Heart Association/American College of Cardi-
of early phases of randomized clinical studies indicated a ology (AHA/ACC), screening for dyslipidemias includes de-
significant effect of new drugs on reducing cardiovascular termining the lipid profile (total cholesterol, LDL cholesterol,
risk. This review article aims to present existing triglycerides, HDL cholesterol, non-HDL cholesterol). In ad-
therapeutic options for the treatment of dyslipidemia, as dition to the standard lipid profile, according to the EAS/ESC
well as new therapeutic agents and future perspectives guidelines, measuring apolipoprotein B (Apo B) as a marker
for the treatment of these disorders. of atherogenic lipoproteins is recommended for all patients
with high levels of triglycerides, diabetes, and obesity .
8, 9
Keywords: dyslipidemia, treatment, LDL-c

26 DOI: 10.5937/Galmed2409031L