title: Individualized lipid-lowering therapy to further reduce residual cardiovascular risk.
abstract: Hypercholesterolemia is a major risk factor for cardiovascular diseases. Serum cholesterol concentrations are regulated by enteral absorption, biliary secretion, and hepatic synthesis. Statins inhibit the rate-limiting enzyme of cholesterol synthesis, HMG-CoA-reductase, and reduce serum cholesterol concentrations as well as cardiovascular morbidity and mortality. Some studies indicate that patients with high baseline cholesterol absorption may show only a small response to statin treatment in terms of cholesterol lowering. Data from genetic association studies and from the IMPROVE-IT trial show that reducing intestinal cholesterol absorption via NCP1L1 further reduces cardiovascular risk. However, some patients do not attain LDL-cholesterol targets on combination therapy. For these patients PCSK9-antibody treatment and lipid-apheresis are options to be considered. This article reviews the current literature on this issue and suggests 'individualized lipid-lowering therapy' as an approach to optimize and personalize lipid-lowering treatment of patients with hypercholesterolemia to further reduce residual cardiovascular risk.
authors.affiliation: Department of Cardiology, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany. Electronic address: oweingartner@aol.com.
authors.forename: Oliver
authors.initials: O
authors.lastname: Weingärtner
authors.affiliation: Institute for Clinical Chemistry and Clinical Pharmacology, University Clinics Bonn, Bonn, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Lütjohann
authors.affiliation: Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Torsten
authors.initials: T
authors.lastname: Plösch
authors.affiliation: Department of Cardiology, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
mesh_terms: D000818:Animals; D001781:Blood Component Removal; D002309:Cardiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002784:Cholesterol / Q000737:chemistry; D008078:Cholesterol, LDL / Q000737:chemistry; D056726:Genetic Association Studies; D006801:Humans; D006903:Hydroxymethylglutaryl CoA Reductases / Q000378:metabolism; D006937:Hypercholesterolemia / Q000517:prevention & control; D000960:Hypolipidemic Agents / Q000494:pharmacology*; D008055:Lipids / Q000737:chemistry*; D000071449:Proprotein Convertase 9 / Q000378:metabolism; D012306:Risk; D012307:Risk Factors
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents; D008055:Lipids; D002784:Cholesterol; C553220:HMGCR protein, human; D006903:Hydroxymethylglutaryl CoA Reductases; C472125:PCSK9 protein, human; D000071449:Proprotein Convertase 9
keywords: Cardiovascular risk; Cholesterol; Individualized lipid-lowering therapy