Rational Pharmacotherapy in Cardiology

Advanced search

Correction of Hypercholesterolemia in Primary and Secondary Prevention of Cardiovascular Diseases: Features and Controversial Issues

Full Text:


The article discusses the current prevalence of hypercholesterolemia in everyday clinical practice in patients of different risk categories and approaches to its correction in the most frequently used clinical guidelines. High prevalence of hypercholesterolemia in practical health care with little change over time is shown. The existing problems of the practical implementation of the principles of a healthy lifestyle as the basis for reducing cardiovascular risk and possible solutions are described. Attention is focused on a low number of patients taking statins, and even less – reaching recommended target cholesterol levels. It is emphasized the validity of lower, compared to previous, target cholesterol levels in National recommendations on the correction of dyslipidemia in patients with proven atherosclerosis-related cardiovascular diseases as well as the feasibility in some cases of combined lipidlowering therapy (statins in combination with intestinal cholesterol absorption blockers, PCSK9 inhibitors, high doses of ethyl eicosopentaenoic acid). It is commented the need to prescribe statins in persons older than 75 years, but with a careful approach. Particular attention is paid to the use of statins in the primary prevention of cardiovascular complications. The validity of prescribing fixed moderate doses of statins for this purpose is discussed, which is both scientifically based and more realistic in practical terms.

About the Authors

N. M. Akhmedzhanov
National Research Center for Preventive Medicine
Russian Federation
MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention

D. V. Nebieridze
National Research Center for Preventive Medicine
Russian Federation
MD, PhD, Professor, Head of Department of Metabolic Disorders Prevention,

A. S. Safaryan
National Research Center for Preventive Medicine
Russian Federation
MD, PhD, Leading Researcher, Department of Metabolic Disorders Prevention


1. Shalnova S.A., Conradi A.O., Karpov Yu.A., et al. Analysis of mortality from cardiovascular disease in 12 regions of the Russian Federation, participating in the study ”Epidemiology of cardiovascular disease in different regions of Russia”. Russian Journal of Cardiology. 2012;5:6-11. (In Russ.)

2. Yusuf S., Hawken S., Ounpuu S., et al. Effect of potentially modifiable risk factors associated with myocardialinfarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937-52. doi:10.1016/S0140-6736(04)17018-9.

3. Metelskaya V.A., Shalnova S.A., Deev A.D., et al. An analysis of the prevalence of indicators characterizing the atherogenicity of the lipoprotein spectrum in residents of the Russian Federation (according to the ESSE-RF study). Prophylactic Medicine. 2016;19(1):15-23. (In Russ.)

4. Muromtseva G.A., Kontsevaya A.V., Konstantinov V.V. et al. The prevalence of non-infectious diseases in Russian population in 2012-2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014;13(6):4-11. (In Russ.)

5. Balanova Y.A., Vilkov V.G., Dotsenko A.N., et al., The results of second stage of monitoring of epidemiological situation of arterial hypertension in the Russian Federation (2005-2007), conducted within framework of the Federal Social Program “Prevention and Treatment of Arterial Hypertension in the Russian Federation”. Information-statistical compendium. Moscow: GNITS PM; 2008. (In Russ.)

6. Diagnosis and correction of lipid metabolism disorders for the prevention and treatment of atherosclerosis. Russian recommendations (VI revision). [cited by Dec 12, 2018]. Available from: (In Russ.) Доступно на: sites/default/files/references_v6.pdf]

7. Catapano A.L., Graham I., De Backer G., et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016;37(39):2999-3058. doi: 10.1093/eurheartj/ehw272.

8. Zagrebelnyi A.V., Martsevich S.Yu., Lukyanov M.M., et al. Quality of lipid-lowering therapy in outpatient practice: RECVASA Register data. Prophylactic Medicine. 2016;19(1):9-14. (In Russ.)

9. Martsevich S.Yu., Gaisenok O.V., Tripkosh S.G., et al. Real practice of statins use and its dependence on follow-up in the specialized medical centre in patients with high cardiovascular risk (according to the PROFILE register) Rational Pharmacotherapy in Cardiology. 2013;9(4):362-7. (In Russ.) doi:10.20996/1819-6446-2013-9-4-362-367.

10. Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S., et al. Analysis of prevalence of hypercholesterolemia in outpatient practice (According to ARGO research): Part 1. Rational Pharmacotherapy in Cardiology. 2015;11(3):253-60. (In Russ.) doi:10.20996/1819-6446-2015-11-3-253-260.

11. Ezhov M.V., Bliznyuk S.A., Alekseeva I.A., Vygodin V.A. Prevalence of hypercholesterolemia and statins intake in the outpatient practice in the Russian Federation (ICEBERG study). Atherosclerosis and Dyslipidemias. 2017;4(29):5-17. (In Russ.)

12. Miller V., Mente A., Dehghan M., et al. on behalf of the Prospective Urban Rural Epidemiology (PURE) study investigators. Fruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE): a prospective cohort study. Lancet. 2017;390:2037-49. doi:10.1016/S0140-6736(17)32253-5.

13. King D.E., Mainous III A.G., Carnemolla M., Adherence to Healthy Lifestyle Habits in US Adults,1988-2006. Am J Med. 2009:122:528-34. doi:10.1016/j.amjmed.2008.11.013.

14. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Scandinavian Simvastatin Survival Study Group. Lancet. 1994;344(8934):1383-9. doi:10.1016/S0140-6736(94)90566-5.

15. Spector R., Snapinn S.M. Statins for Secondary Prevention of Cardiovascular Disease: The Right Dose. Pharmacology. 2011;87:63-9. doi:10.1159/000322999.

16. Stone N.J., Bailey A.L., Jones D.W., et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/ AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol. A Report of the American College of Cardiology/American Heart Association Task Force onClinical Practice Guidelines. Circulation. 2018;000:e000-e000. doi:10.1161/CIR.0000000000000625.

17. Cannon C.P., Michael A. et al. for the IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372:2387-97. doi:10.1056/ NEJMoa1410489.

18. Sabatine M.S., Giugliano R.P., Keech A.C., et al., FOURIER Steering Committee and Investigators. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713-22. doi:10.1056/NEJMoa1615664.

19. Schwartz G.G., Steg P.G., Szarek M., et al., ODYSSEY OUTCOMES Committees and Investigators. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018;379(22):2097-107. doi:10.1056/NEJMoa1801174.

20. Bhatt D.L., Steg G., Miller M., et al., for the REDUCE-IT Investigators. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2018 Nov 10. doi:10.1056/ NEJMoa1812792. [Epub ahead of print]

21. Sever P.S., Dahlöf B., Poulter N.R., et al., for the ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicenter randomised controlled trial. Lancet. 2003;361:1149-58. doi:10.1016/ S0140-6736(03)12948-0.

22. Yusuf S., Bosch J., Dagenais G., et al. for the HOPE-3 Investigators. Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease. N Engl J Med. 2016;374:2021-31. doi:10. 1056/NEJMoa1600176.

23. Singh S., Zieman S., Go A.S., et al. Statins for Primary Prevention in Older Adults-Moving Toward Evidence-Based Decision-Making. J Am Geriatr Soc. 2018;66(11):2188-96. doi:10.1111/ jgs.15449.


For citations:

Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S. Correction of Hypercholesterolemia in Primary and Secondary Prevention of Cardiovascular Diseases: Features and Controversial Issues. Rational Pharmacotherapy in Cardiology. 2018;14(6):917-921.

Views: 533

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)