Management of Hypercholesterolaemia for Cardiovascular Risk Reduction: A Malaysian Perspective
Jeyamalar Rajadurai1*, Wan Azman Wan Ahmad2, Hapizah Nawawi3, Choo Gim Hooi4, Ng Wai Kiat5, Rosli Mohd Ali4, Al Fazir Omar4, Sazzli Kasim6 and David Quek Kwang Leng5
1Subang Jaya Medical Centre, Selangor, Malaysia
2Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
3I-PPerForM and Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh Campus, Malaysia
4Cardiac Vascular Sentral, Kuala Lumpur, Malaysia
5Pantai Hospital, Kuala Lumpur, Malaysia
6Faculty of Medicine, Universiti Teknologi MARA, Sg Buloh Campus, Selangor, Malaysia
*Corresponding Author: Jeyamalar Rajadurai, Subang Jaya Medical Centre, Selangor, Malaysia.
January 24, 2022; Published:
Cardiovascular disease (CVD) is a major health problem worldwide. Primary preventive population-based strategies aimed at improving global cardiovascular (CV) health is being advocated universally. In addition, specific CV risk factors need to be addressed. This paper focusses on the management of hypercholesterolaemia from a Malaysian perspective and also discusses the newer lipid lowering agents. In individuals at low and intermediate CV risk, lifestyle modification alone may suffice. This encompasses a pragmatic and healthy diet, weight management and increased physical activity. In individuals at high and very high CV risk however, in addition to lifestyle modification, drug therapy is almost always necessary to achieve the target Low Density Lipoprotein Cholesterol (LDL-C) levels which have been shown to improve CV outcomes. In clinical trials, very low LDL-C levels (< 1.4 mmol/l) have been shown to retard progression and sometimes even result in regression of atherosclerotic plaques. Statins are the first-line drugs because there is robust data that they are both effective and safe. Such low target LDL-C levels (< 1.4 mmol/l) however are sometimes not achievable despite maximally tolerated statin therapy and lifestyle modification. The addition of ezetimibe and/or Proprotein convertase subtilisin/kexin type 9 Inhibitors (PCSK9-i) to statins may be necessary to achieve these targets.
Keywords: Cardiovascular Disease; Hypercholesterolaemia; Statins; Familial Hypercholesterolaemia; Statin Intolerance; Ezetimibe; PCSK9-inhibitor
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