Introduction.
Dyslipidemia is basically improved through diet and exercise, but if the numbers are significantly high or there is a risk of complicationspharmacotherapyis required.
In recent years, new drugs have been introduced, expanding the range of options available. In this issue, we will organize the drugs used for dyslipidemia in an easy-to-understand manner.
1. main types of drugs used for dyslipidemia
(1) Statin (HMG-CoA reductase inhibitor)
- effect: Strongly lowers LDL cholesterol (20-50% lower)
- specific medicine(e.g., atorvastatin, rosuvastatin, pravastatin, etc.)
- side effectHepatic dysfunction, myalgia (rhabdomyolysis is rare)
- feature: strongest preventive effect against myocardial infarction and cerebral infarction, first-line drug
(2) Fibrates
- effect: lowers triglycerides and raises HDL (good)
- specific medicineFenofibrate, bezafibrate
- side effect: Hepatic impairment, impaired renal function, muscle impairment (caution with statins)
- feature: useful for patients with hypertriglyceridemia and low HDL
(3) Ezetimibe
- effectInhibits cholesterol absorption in the intestinal tract
- feature: can further lower LDL when used in combination with statins
- side effect: Gastrointestinal symptoms, liver problems (when used with statins)
(4) PCSK9 inhibitors
- effect: potent drug that lowers LDL by 50-60%.
- specific medicineEvolocumab, Alirocumab (injection)
- feature: Used for familial hypercholesterolemia and patients who do not lower cholesterol adequately with statins.
- important pointHigh cost (subject to insurance coverage)
(5) EPA preparation (eicosapentaenoic acid)
- effectLowers triglycerides and inhibits arteriosclerosis
- specific medicineEthyl icosapentate
- feature: reported to be effective in reducing cardiovascular events when used in combination with statins.
2. use of different medicines
- High LDL cholesterol → Statins are the first choice
- High neutral fat → Fibrate or EPA preparation
- Statins alone are not enough. → Ezetimibe added
- Familial hypercholesterolemia and severe cases → PCSK9 inhibitor
3. when to start the drug
- LDL cholesterol. 160 mg/dL or higher
- Multiple risks such as diabetes, hypertension, smoking, etc.
- If you have already had a myocardial or cerebral infarction (essential to prevent recurrence)
In the guidelines,Overall risk assessment (age, blood pressure, diabetes, smoking history, etc.) The decision to initiate a drug is based on the
4. taking precautions while taking the medicine
- Routine blood testsCheck: liver function, kidney function, CK (muscle)
- Consult as soon as possible if there are side effectsMuscle pain, abnormal color of urine, severe fatigue, etc.
- We don't stop without permission.: when interrupted, LDL returns quickly and the risk increases again!
5. efforts at Ikejiri-Ohashi Sera Clinic
For dyslipidemia in our hospital
- Blood test + fundus, ABI, carotid artery echoVisualizing the risk of atherosclerosis with
- Lifestyle improvement (diet, exercise, medical diet) and medicationSupport for
- Cross-cutting management of diabetes, hypertension, MASLD (fatty liver), and dyslipidemia
We practice a comprehensive approach that includes
summary
- Dyslipidemia medications are,Statins are fundamentaland add other medications as needed.
- If triglycerides are high, fibrates and EPA preparations are also effective.
- If statins are insufficient, consider ezetimibe or PCSK9 inhibitors.
- At Ikejiri-Ohashi Sera Clinic, we integrate examination + lifestyle improvement + drug therapy + exercise therapyThe company supports the project by providing
References
- The Japanese Society for Arteriosclerosis. Guidelines for the Prevention of Arteriosclerotic Disease 2022.
- Grundy SM, et al. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. J Am Coll Cardiol. 2019
- Cannon CP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015
- Sabatine MS, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017
Symptoms and Causes of Dyslipidemia