The significance and treatment of dyslipidaemia in young adults

Česká verzia

Authors: M. Vráblík ¹; M. Šatný ¹; J. Laštůvka ²
Authors place of work: III. interní klinika 1. LF UK a VFN v Praze 2 Interní oddělení, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní, a. s. ¹
Published in the journal: Kardiol Rev Int Med 2018, 20(2): 112-116

Summary

Dyslipidaemia (DLP) fundamentally affects the onset and development of atherosclerosis since birth. Most disorders of plasma lipoprotein metabolism have a genetic basis. For these reasons, DLP diagnostics and interventions need to be addressed from low age categories. In this review we will not deal with DLP in children, but we will focus on diagnosis and treatment of these metabolic disorders in young adults up to 40 years of age. This population is characterized by mostly low absolute cardiovascular (CV) risk, although the relative risk can be significantly increased. We do not have sufficient tools to estimate this risk in these age categories. For this reason, other possibilities of stratification of CV risk, including the use of imaging methods, are at the forefront of attention. Younger patients are characterized by lower adherence to treatment and less willingness to get diagnosed and initiate treatment. At the same time, early intervention is currently one of the new approaches advocated in preventive cardiology as an opportunity to further improve its (already very good) results. All young patients with DLP should be treated with non-pharmacological means. Their effectiveness is demonstrated by a number of studies, and it is important that they also act as treatment and prevention of other metabolic diseases (obesity, type 2 diabetes mellitus). Today, we can enhance the effect of a change of regime by recommending products from the group of nutraceuticals, i.e. active dietary ingredients with lipid-modifying effects (e.g. monacolin, plant sterols). Although they lack evidence of their effect on morbidity and mortality, they are a supplement to dietary and regime measures with proven effects on atherogenic serum lipid levels. Pharmacological treatment is generally delayed in young adults, particularly in women who are worried about complications in pregnancy. However, such an approach is not often appropriate because deferral of effective pharmacological therapy prolongs the period when the vascular walls are exposed to high levels of atherogenic lipoproteins (especially in the LDL class) to produce irreversible atherosclerotic changes. Pharmacological intervention in young patients is targeted primarily at achieving the recommended LDL-cholesterol level, which is the primary therapeutic target. In patients with mixed DLP we aim to achieve the target value of non-HDL-cholesterol or apolipoprotein B as secondary therapeutic targets. This is also reflected in the choice of pharmacotherapy; we usually start the treatment with statins for which we have evidence of efficacy and long-term safety. If it is not possible to achieve the monotherapy targets even after titration of the treatment to high intensity (atorvastatin 40 mg per day, rosuvastatin 20–40 mg daily), we choose a combination with ezetimibe. Other options for combination therapy in young adults are based on general recommendations.

Key words:
dyslipidaemia – young adults – LDL-cholesterol – cardivoascular risk – statins – lifestyle changes

Zdroje

1. Yusuf S, Hawken S, Ounpuu S. INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364(9438): 937– 952. doi: 10.1016/ S0140-6736(04)17018-9.

2. Ference BA, Ginsberg HN, Graham I et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J 2017; 38(32): 2459– 2472. doi: 10.1093/ eurheartj/ ehx144.

3. Vrablík M, Freiberger T, Bláha V et al. Souhrn konsenzu panelu expertů European Atherosclerosis Society k otázce diagnostiky a klinickému vedení nemocných s familiární hypercholesterolemií. Hypertenze a kardiovaskulární prevence 2015; 4(1): 54– 56.

4. Strong JP, Oalmann MC, Newman WP 3rd et al. Coronary heart disease in young black and white males in New Orleans: Community Pathology Study. Am Heart J 1984; 108 (3 Pt 2): 747– 759.

5. Widimský J, Filipovský J, Ceral J et al. Doporučení pro diagnostiku a léčbu arteriální hyperteze ČSH 2017. Hypertenze a kardiovaskulární prevence 2018; 7 (Suppl): 1– 20.

6. Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016; 252: 207– 274. doi: 10.1016/ j.atherosclerosis.2016.05.037.

7. Steinl DC, Kaufmann BA. Ultrasound imaging for risk assessment in atherosclerosis. Int J Mol Sci 2015; 16(5): 9749– 9769. doi: 10.3390/ ijms16059749.

8. Raggi P. Atherosclerosis imaging to refine cardiovascular risk assessment in diabetic patients: computed tomography and positron emission tomography applications. Atherosclerosis 2018; 271: 77– 83. doi: 10.1016/ j.atherosclerosis.2018.02.021.

9. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007; 14 (Suppl 2): S1– S113. doi: 10.1097/ 01.hjr.0000277983.23934.c9.

10. Gidding SS, Rana JS, Prendergast C et al. Pathobiological determinants of atherosclerosis in youth (PDAY) risk score in young adults predicts coronary artery and abdominal aorta calcium in middle age: The CARDIA Study. Circulation 2016; 133(2): 139– 146. doi: 10.1161/ CIRCULATIONAHA.115.018042.

11. Ference BA, Yoo W, Alesh I et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol 2012; 60(25): 2631– 2639. doi: 10.1016/ j.jacc.2012.09.017.

12. Baigent C, Blackwell L, Emberson J et al. Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376(9753): 1670– 1681. doi: 10.1016/ S0140-6736(10)61350-5.

13. Chmelík Z, Vrablík M, Vaclová M et al. Vysoká prevalence kardiovaskulárních rizikových faktorů a neuspokojivá kontrola hladin LDL-cholesterolu v populaci 40letých mužů a 50letých žen v České republice. AtheroRev 2016; 1(3): 111– 115.

14. Vrablík M, Štěpánková L. Kouření, kardiovaskulární komplikace a léčba závislosti na tabáku. Kardiol primární péči 2008; 3: 98– 101.

15. Brát J. Mýty v oblasti diety a prevence aterosklerózy. AtheroRev 2017; 2(2): 136– 141.

16. Vrablík M, Piťha J, Bláha V et al. Stanovisko výboru České společnosti pro aterosklerózu k doporučením ESC/ EAS pro diagnostiku a léčbu dyslipidemií z roku 2016. Hypertenze a kardiovaskulární prevence 2017; (6)2: 23– 31.

17. Piťha J, Vrablík M. Rostlinné steroly a stanoly: zatím samy v doporučeních pro obohacování diety s cílem snížení hladin LDL cholesterolu a KV rizika. Hypertenze a kardiovaskulrání prevence 2015; 4(1): 52– 53.

18. Cicero AF, Colletti A, Bajraktari G et al. Lipid-lowering nutraceuticals in clinical practice: position paper from an International Lipid Expert Panel. Nutr Rev 2017; 75(9): 731– 767. doi: 10.1093/ nutrit/ nux047.

19. Ford I, Murray H, McCowan C et al. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scotland Coronary Prevention Study. Circulation 2016; 133(11): 1073– 1080. doi: 10.1161/ CIRCULATIONAHA.115.019014.

20. Urbanová Z, Freiberger T, Šamánek M et al. Komentář k souhrnu konsenzu panelu expertů EAS k otázce optimalizace diagnostiky a léčby dětí s familiární hypercholesterolemií. Hypertenze a kardiovaskulární prevence 2016; 5(1): 36– 38.

21. Vrablík M. Fixní kombinace s hypolipidemiky. Kardiol Rev Int Med 2016; 18(2): 98– 103.

22. Parker BA, Capizzi JA, Grimaldi AS et al. Effect of statins on skeletal muscle function. Circulation 2013; 127(1): 96– 103. doi: 10.1161/ CIRCULATIONAHA.112.136101