Lipid-lowering therapy in special situations

The review is devoted to the use of lipid-lowering medicines in certain categories of patients, especially those with acute coronary syndrome, stroke, chronic heart failure, valvular heart disease, atherosclerosis of the central and peripheral arteries, chronic kidney disease, as well as in persons undergoing percutaneous coronary intervention. It is noted that all patients with acute coronary syndrome without any contraindications or intolerance are advised to start (or continue) high-dose statin therapy as early as possible, regardless of the initial values ​​of low-density lipoprotein cholesterol. If the target level of low density lipoproteins is not reached after 4-6 weeks of using the maximum tolerated dose of statins, a combination with ezetimibe is recommended, and if this combination is not effective enough, the addition of a proprotein convertase inhibitor subtilisin / kexin type 9 is needed. Strategy of short pre-treatment or loading (in the case of prior therapy) with high doses of statins should be considered for elective percutaneous coronary intervention or acute coronary syndrome without ST-segment elevation. The use of statins to lower cholesterol levels is not indicated in patients with heart failure unless otherwise indicated. Lipid-lowering therapy for atherosclerotic lesions of the carotid arteries significantly reduces the risk of stroke. Recommendations for the treatment of dyslipidemia in organ transplant patients are comparable to those used for patients at high or very high risk of cardiovascular disease, although more attention needs to be paid to the causes of lipid abnormalities and possible side effects associated with drug interactions.