From the Guidelines
A person with hyperlipidemia should be treated with a regimen that includes lifestyle modifications and medication, with the goal of reducing LDL-C to 100 mg/dL, and further reduction to 70 mg/dL is reasonable, as recommended by the 2006 update of the AHA/ACC guidelines 1. The treatment plan should include:
- Lifestyle changes such as adopting a heart-healthy diet low in saturated fats and trans fats, rich in fruits, vegetables, whole grains, and lean proteins
- Regular physical activity of at least 150 minutes of moderate-intensity exercise per week
- Weight loss if overweight, smoking cessation, and limiting alcohol consumption
- Dietary therapy to reduce intake of saturated fats, trans-fatty acids, and cholesterol
- Adding plant stanol/sterols and viscous fiber to further lower LDL-C
- Promoting daily physical activity and weight management
- Encouraging increased consumption of omega-3 fatty acids For medications, the options include:
- Statins as first-line therapy
- Ezetimibe for additional lipid lowering
- PCSK9 inhibitors for severe cases
- Fibrates or omega-3 fatty acids for high triglycerides The goal of treatment is to reduce LDL cholesterol by at least 30-50% from baseline, with specific targets based on individual cardiovascular risk, and treatment success is monitored through lipid panels every 3-6 months initially, then annually once targets are reached, as supported by the standards of medical care in diabetes--2008 1. Key considerations in treatment include:
- Assessing fasting lipid profile in all patients
- Initiating lipid-lowering medication as recommended before discharge
- Intensifying LDL-lowering drug therapy if on-treatment LDL-C is 100 mg/dL
- Treating to LDL-C 70 mg/dL if baseline LDL-C is 70 to 100 mg/dL
- Using therapeutic options such as more intense LDL-C–lowering therapy, niacin, or fibrate therapy to reduce non-HDL-C.
From the FDA Drug Label
Assess LDL-C when clinically appropriate, as early as 4 weeks after initiating ezetimibe tablets. The regimen for a person with hyperlipidemia is to administer ezetimibe tablets, with LDL-C assessment as soon as 4 weeks after initiation.
- The dosage is 10 mg daily.
- Administration should be at least 2 hours before or 4 hours after administration of a bile acid sequestrant. 2
From the Research
Regimen for Hyperlipidemia
The regimen for a person with hyperlipidemia typically involves a combination of lifestyle modifications and pharmacological interventions.
- The primary goal of treatment is to reduce low-density lipoprotein (LDL) cholesterol levels and decrease the risk of atherosclerotic cardiovascular disease (ASCVD) 3.
- Statins are recommended as a first-line therapy for the primary and secondary prevention of ASCVD, but they may not be sufficient in decreasing LDL cholesterol levels in all patients 3.
- In such cases, additional hyperlipidemic agents such as ezetimibe, a cholesterol absorption inhibitor, may be used in combination with statins to achieve additional LDL cholesterol reduction and reduce ASCVD risk 3, 4.
- Ezetimibe has been shown to be effective in reducing LDL cholesterol levels and decreasing the risk of major cardiovascular events when added to statin therapy 4, 5, 6.
- The combination of ezetimibe and simvastatin has been found to be more effective in reducing LDL cholesterol levels than atorvastatin alone in some studies 5, 6.
- Monoclonal antibodies such as alirocumab and evolocumab, which target proprotein convertase subtilisin/kexin type 9 (PCSK9), have also been approved to lower LDL cholesterol levels and reduce ASCVD risk 3.
Treatment Options
Treatment options for hyperlipidemia may include:
- Statin monotherapy
- Combination therapy with ezetimibe and a statin
- Combination therapy with a PCSK9 inhibitor and a statin
- Lifestyle modifications such as diet and exercise
- The choice of treatment will depend on the individual patient's needs and medical history 3, 4, 5, 6, 7.
Efficacy and Safety
The efficacy and safety of these treatment options have been evaluated in several studies.
- Ezetimibe has been found to be generally well tolerated and effective in reducing LDL cholesterol levels 4, 5, 6.
- The combination of ezetimibe and simvastatin has been found to be safe and effective in reducing LDL cholesterol levels and decreasing the risk of major cardiovascular events 5, 6.
- PCSK9 inhibitors have been found to be effective in reducing LDL cholesterol levels, but may be associated with a higher risk of adverse events such as injection site reactions 3.