Correction of Dyslipidemia: Historical Aspect and Current View of the Problem (Review, Part Iі)

Aim. To summarize scientific publications, clinical guidelines (CG) regarding the development of standardized approaches to the correction of dyslipidemia and the introduction of new hypolipidemic drugs at the current stage. Materials and methods. The analysis and generalization of scientific articles, clinical guidelines on the introduction of standardized approaches to the correction of dyslipidemia at the current stage and the use of new hypolipidemic drugs for the prevention and treatment of cardiovascular diseases (CVD) were carried out. Methods were used: systematic approach, bibliosemantic, analytical. Results. Modern standardized approaches to the appointment of hypolipidemic therapy for the primary and secondary prevention of atherosclerotic CVD are based on the definition of the general cardiovascular risk, which is regulated by CG. Meta-analyses of clinical trials have shown that the relative reduction of CVD risk is proportional to the absolute reduction in low-density lipoprotein cholesterol levels, regardless of the drug(s) used. Statins remain the drugs of the first line of hypolipidemic therapy. In accordance with modern clinical practice, it is recommended to prescribe statins in maximum tolerated doses and use combined therapy with new hypolipidemic drugs when the target level of indicators is not reached. Combinations with statins start with ezetimibe, in case of insufficient efficacy, it is recommended to add a PCSK9 inhibitor (evolocumab, alirocumab, incliziran). Wider use of PCSK9 inhibitors is limited by the high cost of drugs of this group. CG 2023 and 2024 recommend the use of another new drug – bempedic acid – in clinical practice for the correction of dyslipidemia. Conclusions. The introduction of modern approaches, in particular regarding the combination of hypolipidemic therapy drugs, which are adapted to each clinical case, provide new opportunities for primary and secondary prevention of CVD, which requires additional funds of the health care system.