2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP).

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries.
Competing Interests: Declarations. Funding: No external funding was used in the preparation of this article. Conflict of interest: Dr. Banach has received research grant(s)/support from Amgen, Daiichi-Sankyo, Mylan/Viatris, and Sanofi, and has received honoraria and/or served as a consultant for Adamed, Amgen, Daiichi-Sankyo, Esperion, Kogen, KRKA, Lilly, MSD, Mylan/Viatris, NewAmsterdam Pharma, Novartis, Novo Nordisk, Polfarmex, Polpharma, Sanofi-Regeneron, Servier, Teva, and Zentiva. Dr. Reiner has received honoraria from Sanofi and Novartis. Dr. Cicero has received personal fees from Mylan-Viatris, Sharper, and Servier. Dr. Dyrbuś has received fee for scientific activities from Novartis, Sanofi-Aventis, and Amgen. Dr. Fedacko has received a consultancy fee from Sanofi, Amgen and Novo Nordisk, and a research grant from Pfizer. Dr. Fras has received grants and fees for scientific activities from Amgen, Krka, Novartis, Swix BioPharma, and Viatris. Dr. Gaita has received honoraria from Amgen, AstraZeneca, Bayer, Berlin Chemie, Biofarm, Boehringer Ingelheim, Galenica, GSK, Gedeon Richter, Krka, MSD, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier, Terapia, Vifor Pharma, and Zentiva. Dr. Gierlotka reports honoraria from Sanofi, Novartis, Bayer, Amgen, Novo Nordisk, AstraZeneca, Servier. Dr. Gouni-Berthold has served as consultant and received honoraria from Akcea, Amgen, Daiichi-Sankyo, Novartis, Sanofi-Regeneron, Ultragenyx, and Amarin. Dr. Jankowski has received a research grant from Sanofi and has served as a consultant for Novartis, Servier, and Zentiva. Dr. Járai has served as a consultant for and received honoraria from Bayer, Berlin-Chemie, Boehringer Ingelheim, Egis, MSD, Novartis (Sandoz), Novo Nordisk, Pfizer, Richter Gedeon, Sanofi, Servier, and Teva. Dr. Latkovskis has given talks, attended conferences, received consultancy fees, and/or participated in trials sponsored by Abbott Laboratories, Amgen, AstraZeneca, Berlin-Chemie/Menarini, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Grindex, KRKA, MSD, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier Laboratories, Siemens Laboratories, and Zentiva. Dr. Magda has received consultation fees from Novartis, Sanofi, and Servier. Dr. Margetic has received a fee for scientific activities from Novartis and Sanofi. Dr. Ostadal has received honoraria from Getinge, Abiomed, Edwards, Fresenius/Xenios, AstraZeneca, Bayer, Boehringer Ingelheim, Amgen, Sanofi, Servier, Novartis, Pfizer, AOP, and GSK. Dr Paragh has received lectures fees from Hungarian branches of Novartis, Richter Gedeon, and Sandoz. Dr. Paneni has received honoraria from Novo Nordisk. Dr. Pećin has received grants and fees for scientific activities from Amgen, Bayer, Novartis, and Sanofi. Dr. Pella has received grant support and honoraria from Sanofi, Amgen, MSD, Servier, Novartis, and Pfizer. Dr. Postadzhiyan reports fees for educational activities from Amgen, AstraZeneca, KRKA, Novartis, Servier, Teva, and Zentiva. Dr. Stoian has given lectures, received honoraria and research support, and participated in conferences, advisory boards, and clinical trials sponsored by pharmaceutical companies, from AstraZeneca, Amgen, Boehringer Ingelheim, Coca-Cola, Eli Lilly, Merck, Medtronic, MSD, Medochemie, Novo Nordisk, Novartis, Roche Diagnostics, Servier, Sandoz, and Sanofi. Dr. Trbusic has received a fee for scientific activities from Novartis and Sanofi. Dr. Udroiu has received a fee for scientific activities from AstraZeneca and Pfizer. Dr. Viigimaa reports fees for educational activities from Amgen, AstraZeneca, Novartis, Novo Nordisk, Menarini, Servier, and Swixx BioPharma. Dr. Vinereanu has received research grants and expert fees from Amgen, Sanofi, Novartis, and Servier. Dr. Vlachopoulos has received grants and fees for scientific activities from Amgen, Sanofi, and MSD. Dr. Vrablik has received personal fees from Abbott, Amgen, AstraZeneca, BMS, Genzyme, KRKA, MSD Idea, Novartis, Pfizer, and Sanofi-Regeneron. Dr. Vulic has received a fee for scientific activities from Sanofi. Dr. Penson owns four shares in AstraZeneca PLC and has received honoraria from Amgen and Sanofi and travel/accommodation reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Mylan, and Napp. All other authors declare that they have no potential conflicts of interest that might be relevant to the contents of this article. Authors’ contributions: Dr. Banach: Conceptualisation; data curation; methodology; project administration; supervision; validation; visualisation; writing, reviewing, and editing; revisions; preparing the final version of the paper. Dr. Penson: Data curation; investigation; methodology; validation; visualisation; first draft preparation; reviewing and editing. Dr Surma: data curation, visualisation, draft figures preparations; reviewing and editing. Drs. Reiner, Bajraktari, Bielecka-Dabrowa, Bunc, Bytyçi, Ceska, Cicero, Dudek, Dyrbuś, Fedacko, Fras, Gaita, Gavish, Gierlotka, Gil, Gouni-Berthold, Jankowski, Járai, Jóźwiak, Katsiki, Latkovskis, Magda, Margetic, Margoczy, Mitchenko, Durak-Nalbantic, Ostadal, Paragh, Petrulioniene, Paneni, Pećin, Pella, Postadzhiyan, Stoian, Trbusic, Udroiu, Viigimaa, Vinereanu, Vlachopoulos, Vrablik, and Vulic: Investigation, methodology; validation; writing, reviewing, and editing; final revisions and approval. Data availability statement: Data sharing is not applicable to this article as no datasets were generated for this article. Ethics approval: Not applicable. Code availability: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable.
(© 2024. The Author(s).)