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Beyond Statins: Lipid Management to Reduce Cardiovascular Risk

Authors

  • Robert N. Schuck,

    1. Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
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  • Philip M. Mendys,

    1. Division of Cardiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
    2. Pfizer, U.S. Medical Affairs and Division of Cardiology, Chapel Hill, North Carolina
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  • Ross J. Simpson Jr.

    Corresponding author
    1. Division of Cardiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
    • Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
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  • This publication was made possible, in part, by a predoctoral fellowship from the American Heart Association (11PRE7240059) to R.N. Schuck.
  • P.M. Mendys is employed by Pfizer Inc., and R.J. Simpson has received consulting and/or lecture fees from Merck & Co., Inc., Pfizer Inc., and LipoScience Inc.

For questions or comments, contact Ross J. Simpson, Jr., 6033 Burnett-Womack CB7075, 160 Dental Drive, Chapel Hill, NC, 27599; e-mail: ross_simpson@med.unc.edu

Abstract

The discovery that elevated total cholesterol levels and the subsequent understanding that low-density lipoprotein cholesterol levels are associated with higher risk for cardiovascular disease (CVD) has led to the development of lipid management strategies that seek to reduce the burden of CVD. Although substantive progress has been made in reducing death and cardiovascular events, questions remain regarding the optimal approach to further reduce CVD-associated death and disability. Based on current evidence, statins are the clear first-line agents for the management of hyperlipidemia in patients at high risk for cardiovascular events. However, due to the failure of recent clinical trials evaluating antihyperlipidemic drugs, the most appropriate lipid management strategy in patients who cannot tolerate statin therapy or who warrant antihyperlipidemic therapies in addition to statins is a major therapeutic controversy. In this review, we summarize the clinical trial evidence evaluating the efficacy of second-line antihyperlipidemic drug classes for reducing cardiovascular risk, provide recommendations for appropriate use of nonstatin lipid-altering drugs, and identify key areas of future research to support evidence-based lipid management. Given the complexity, magnitude, and burden of CVD, opportunities to improve processes of care and identify new therapeutic options clearly exist.

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