Management of residual risk after statin therapy

- Statins remain the cornerstone of lipid management for cardiovascular risk reduction.
- Additional risk reduction can be achieved by concomitant use of other lipid-lowering therapies.
- Ezetimibe is the drug most commonly added to statins for cardiovascular risk reduction.
- New drugs such as PCSK9 inhibitors provide additional LDL-lowering and may prove valuable as a therapeutic tool.

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Observational data indicate that low-density lipoprotein cholesterol (LDL-C) levels are strongly positively associated with the risk of coronary heart disease (CHD) whilst the level of high-density lipoprotein cholesterol (HDL-C) is strongly inversely associated, with additional associations being observed for other lipid parameters such as triglycerides, apolipoproteins and lipoprotein(a) (Lp(a)). This has led to an interest in the development of a range of lipid intervention therapies. The most widely used of these interventions are statins, but even with intensive statin therapy some groups of patients remain at significant residual cardiovascular (CV) risk. In addition, some people are intolerant of statin therapy. In these circumstances, additional therapeutic agents may be needed. This review considers the evidence behind and the pros and cons of such additional agents.