High levels of LDL cholesterol – management algorithms

Hypercholesterolemia, or elevated levels of LDL fraction cholesterol, is one of the major cardiovascular (CV) risk factors. For this lipid metabolism disorder, pharmacotherapy is used in addition to the use of non-pharmacological methods (performing regular aerobic physical activity, eating a diet low in saturated fat, maintaining body weight at normal levels, not smoking tobacco products). The 2021 European Society of Cardiology expert guideline on CV prevention proposes a hypolipemic treatment pathway that should be followed when treating patients with hypercholesterolemia. Treatment usually begins with the inclusion of a potent HMG-CoA reductase inhibitor (statin). If treatment with a statin alone is insufficient to achieve the intended therapeutic effect, a drug that works by another mechanism is added to the therapy: ezetimibe or one of the PCSK9 inhibitors. If a combination of statin and ezetimibe is used, combination formulations containing 2 active substances in one tablet can be used. This paper discusses the management of hypercholesterolemia therapy in daily clinical practice, depending on the CV risk of patients.