Moderne Lipidtherapie

Primary and secondary prevention of cardiovascular diseases is tightly connected to the treatment of lipid disorders – primarily elevated LDL cholesterol levels. For decades the only drugs with proven benefit not only in the reduction of LDL serum levels but also concomitantly of cardiovascular adverse events were statins, supposedly due to their additional pleiotropic effects. This year this view shifted after the IMPROVE-IT study showed a decrease in cardiovascular events due to an additional LDL reduction using a non-statin drug, namely ezetimibe, on top of an existing statin therapy. Also with the novel PCSK9 inhibitors Evolocumab and alirocumab a supra-additive LDL lowering effect in combination with statin drugs has been determined not only in patients with acquired dyslipidemia but also with inherited familial hypercholesterolemia. Post hoc analyses of safety studies suggest a cardiovascular benefit of PCSK9 inhibitors. This review will provide an update on non-statin drugs in the treatment of dyslipidemia and the prevention of cardiovascular diseases.