An update on the measurement and management of cholesterol with specific reference to secondary prevention of cardiovascular disease (CVD)

  • Muhammed Vally University of the Witwatersrand
  • F Kathrada University of the Witwatersrand
  • N Butkow University of the Witwatersrand
Keywords: secondary prevention, LDL-C, Non-HDL-C, high intensity statins, PSCK9 inhibitors, ezetimibe

Abstract

Cardiovascular disease remains the largest contributor to non-communicable adverse disease outcomes. Treatment and prevention of cardiovascular disease have evolved at a dramatic pace in the last 40 years. Serum-cholesterol has emerged as the dominant risk factor for coronary artery disease and events. The link between serum-cholesterol and arterial atherosclerosis is well documented. The attainment of cholesterol goals has historically concentrated on low-density lipoprotein cholesterol (LDL-C) levels. Current evidence and guidelines have shifted to the attainment of non-HDL-C target levels which represent a more thorough inclusion of small dense atherogenic particles. Methods to reduce serum-cholesterol mainly centre around the use of the HMG CoA-reductase inhibitors also known as the statins. High intensity statins like atorvastatin (80 mg) and rosuvastatin (40 mg) are now the preferred starting therapies to lower cholesterol by at least 40–50% in patients with established cardiovascular disease as secondary prevention. In the event of failure of these medications, evidence suggests that the addition of ezetimibe may enhance the total serum-lowering levels to 50–60%. New therapies aimed at inhibiting PCSK9 revealed exciting new targets for LDL-C lowering, but the high cost of these antibodies could preclude access to this therapeutic intervention. Aggressive pursuit of lower LDL-C or non-high-density lipoprotein cholesterol (non-HDL-C) levels may reduce the incidence of secondary myocardial infarctions, strokes and death from cardiovascular disease.

Author Biographies

Muhammed Vally, University of the Witwatersrand
BPharm (Wits), MPS, MSc(Med) Pharmacology Lecturer Division of Clinical and Experimental Pharmacology Department of Pharmacy and Pharmacology School of Therapeutic Sciences Faculty of Health Sciences University of the Witwatersrand
F Kathrada, University of the Witwatersrand
BPharm (Wits), Dip(Nut)(UK), MSc(Med) Pharmacology Lecturer Division of Pharmacology Department of Pharmacy and Pharmacology School of Therapeutic Sciences Faculty of Health Sciences University of the Witwatersrand
N Butkow, University of the Witwatersrand
BSc, MSc, PhD (Wits) Senior Lecturer Division of Clinical and Experimental Pharmacology Department of Pharmacy and Pharmacology School of Therapeutic Sciences Faculty of Health Sciences University of the Witwatersrand
Section
Review Articles