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LDL-Cholesterol: Standards of Treatment 2016: A German Perspective

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An Erratum to this article was published on 26 August 2016

Abstract

Decreasing low-density lipoprotein cholesterol (LDL-C) is one of the few established and proven principles for the prevention and treatment of atherosclerosis. The higher the individual cardiovascular risk, the higher the benefit of lipid-lowering pharmacotherapy. Therefore, treatment options are chosen based on a patient’s total cardiovascular risk. The latter depends not only on the levels of LDL-C but also on the presence of cardiovascular disease (CVD) and on the number and severity of other risk factors. Current guidelines recommend the lowering of LDL-C to 115 mg/dl (3 mmol/l) in patients with low and moderate risk. The LDL-C treatment target is <100 mg/dl (2.6 mmol/l) for patients at high risk and <70 mg/dl (1.8 mmol/l) for patients at very high risk. Although lifestyle measures remain a fundamental part of treatment, many patients require drug therapy to achieve their LDL-C targets. Statins are the drugs of choice, with other options including ezetimibe and the newly available monoclonal antibodies against PCSK9 (proprotein convertase subtilisin/kexin type 9). In some cases, bile acid-binding sequestrants and fibrates can also be considered. Nicotinic acid is no longer available in Germany. PCSK9 antibodies decrease LDL-C about 50–60 % and are well tolerated. Their effects on clinical endpoints are being investigated in large randomized trials. The aim of the present review is to summarize the current guidelines and treatment options for hypercholesterolemia. Moreover, we provide an appraisal of PCSK9 antibodies and propose their use in selected patient populations, particularly in those at very high cardiovascular risk whose LDL-C levels under maximally tolerated lipid-lowering therapy are significantly over their treatment target.

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Authors and Affiliations

  1. Society for the Prevention of Cardiovascular Disease e.V. (DACH), Schulterblatt 120, 20357, Hamburg, Germany

    Winfried März, Alexander Dressel & Eberhard Windler

  2. Synlab Academy, Synlab Holding Germany GmbH, P5, 7, 68167, Mannheim, Germany

    Winfried März

  3. Clinical Institut for Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbrugger Platz, 8036, Graz, Austria

    Winfried März & Hubert Scharnagl

  4. Medical Clinic V (Nephrology, Hypertension, Rheumatology, Endocrinology, Diabetology), Mannheim Medical Faculty, University of Heidelberg, Ludolf Krehl Street 7-11, 68167, Mannheim, Germany

    Winfried März

  5. Center for Endocrinology, Diabetes and Preventive Medicine, University of Cologne, Cologne, Germany

    Ioanna Gouni-Berthold

  6. Department of Angiology, Swiss Cardiovascular Center, University of Bern, Bern, Switzerland

    Günther Silbernagel

  7. Mannheimer Institute for Public Health, Mannheim Medical Faculty, University of Heidelberg, Heidelberg, Germany

    Tanja B. Grammer

  8. Clinic for Cardiology, Charité Medical University, Berlin, Germany

    Ulf Landmesser

  9. Division of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria

    Hans Dieplinger

  10. Preventive Medicine, Clinic and Policlinic for General and Invasive Cardiology, Univerity Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany

    Eberhard Windler

  11. Clinic for Internal Medicine III (Cardiology, Angiology and Medical Intensive Care), University of Saarland, Homburg, Germany

    Ulrich Laufs

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  1. Winfried März
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Correspondence to Winfried März.

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Funding

No external funding was used in the preparation of this manuscript.

Conflict of interest

Winfried März is employed with Synlab Holding Deutschland GmbH, has received research grants from Aegerion Pharmaceuticals, AMGEN, Astrazeneca, Danone Research, Sanofi/Genzyme, Pfizer, and BASF, and has received speaker honoraria from Aegerion Pharmaceuticals, AMGEN, Astrazeneca, Danone Research, Sanofi/Genzyme, Pfizer, BASF, Hoffmann LaRoche, MSD, and Sanofi. Ioanna Gouni-Berthold has received consulting and speaker fees and support for educational activities from Amgen, Sanofi and Genzyme. Günther Silbernagel has received a research grant, consulting fees, and support for travel from Amgen. Ulf Landmesser has received speaker fees from MSD, Pfizer, Amgen, Sanofi, Roche, and Berlin-Chemie. Hans Dieplinger has received speaker honoraria and consulting fees from Amgen and Sanofi-Aventis. Eberhard Windler has received honoraria for consulting and lectures from AMGEN, AstraZenca, MSD, Pfizer, Sanofi, and Unilever. Ulrich Laufs has received speaker honoraria and consulting fees from Amgen, MSD, Sanofi, and Pfizer. Hubert Scharnagl, Alexander Dressel, and Tanja B. Grammer have no conflicts of interest that might be relevant to the contents of this manuscript.

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März, W., Scharnagl, H., Gouni-Berthold, I. et al. LDL-Cholesterol: Standards of Treatment 2016: A German Perspective. Am J Cardiovasc Drugs 16, 323–336 (2016). https://doi.org/10.1007/s40256-016-0179-y

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