42 - Dyslipidemia

Abstract

Elevated cholesterol is a well-established and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). Dyslipidemia refers to either elevated low-density lipoprotein cholesterol (LDL-C) ≥130 mg/dL, elevated triglycerides ≥150 mg/dL, or low high-density lipoprotein cholesterol (HDL-C) <40 mg/dL. CVD risk factors occur more often in combination than in isolation and most patients with hypertension have concurrent dyslipidemia. There is evidence that hypertension and dyslipidemia act synergistically to increase CVD risk. The risk of CVD is related to both the magnitude of elevation of LDL-C and the duration of exposure. Based on the 2018 AHA/ACC/MS Cholesterol Guideline recommendations, clinicians should evaluate a patient’s overall ASCVD risk when considering cholesterol lowering therapy, as many patients with hypertension but without dyslipidemia may benefit from statin therapy. An elevated lipoprotein (a) level is considered a risk-enhancing factor. Accordingly, a comprehensive approach to CVD risk factor modification, especially for hypertension and dyslipidemia, is essential to maximize the reduction in CVD. While some medications have modifying effects on blood pressure and cholesterol, these effects are generally small and overshadowed by the reductions in CVD events. Adjunctive therapies such as ezetimibe and PCSK9 inhibitors will likely soon be joined by a number of novel lipid lowering therapies including bempedoic acid and small interfering RNA molecules, with even greater reductions in lipids without adverse changes in blood pressure. These effects that may translate into further reductions in ASCVD among hypertensive patients dyslipidemia.