Statins & Pharmacotherapy of Dyslipidemia

Statins & Pharmacotherapy of Dyslipidemia

1. Definition & clinical context

• Dyslipidaemia is a disorder of lipoprotein metabolism — lipoprotein overproduction or deficiency — encompassing hypercholesterolaemia, hypertriglyceridaemia and low HDL-cholesterol (G&G 14e Ch.37, p.729).
• It is a major cause of atherosclerotic cardiovascular disease (ASCVD), ischaemic cerebrovascular disease and peripheral vascular disease; cardiovascular disease is the single leading cause of death globally (WHO 2020) (G&G 14e Ch.37, p.729).
• Hypolipidaemic drugs lower plasma lipids and lipoproteins, attracting attention chiefly for their potential to retard accelerated atherosclerosis and prevent cardiovascular events in hyperlipidaemic individuals (KDT 8e Ch.46, p.682).
• The two major clinical sequelae of hyperlipidaemia are atherosclerosis (from elevated apo B-100–containing lipoproteins) and acute pancreatitis (from marked hypertriglyceridaemia, typically > 700–1000 mg/dL when the LPL clearance mechanism saturates) (Katzung 16e Ch.35, pp.659, 662).
• Therapy of dyslipidaemias is centred on reducing the risk of fatal and non-fatal ASCVD events (myocardial infarction, stroke) — not merely on normalising a number (G&G 14e Ch.37, p.733).