Abstract
Dyslipidaemia (DLP) fundamentally affects the onset and development of atherosclerosis since birth. Most disorders of plasma lipoprotein metabolism have a genetic basis.
For these reasons, DLP diagnostics and interventions need to be addressed from low age categories. In this review we will not deal with DLP in children, but we will focus on diagnosis and treatment of these metabolic disorders in young adults up to 40 years of age.
This population is characterized by mostly low absolute cardiovascular (CV) risk, although the relative risk can be significantly increased. We do not have sufficient tools to estimate this risk in these age categories.
For this reason, other possibilities of stratification of CV risk, including the use of imaging methods, are at the forefront of attention. Younger patients are characterized by lower adherence to treatment and less willingness to get diagnosed and initiate treatment.
At the same time, early intervention is currently one of the new approaches advocated in preventive cardiology as an opportunity to further improve its (already very good) results. All young patients with DLP should be treated with non-pharmacological means.
Their effectiveness is demonstrated by a number of studies, and it is important that they also act as treatment and prevention of other metabolic diseases (obesity, type 2 diabetes mellitus). Today, we can enhance the effect of a change of regime by recommending products from the group of nutraceuticals, i.e. active dietary ingredients with lipid-modifying effects (e.g. monacolin, plant sterols).
Although they lack evidence of their effect on morbidity and mortality, they are a supplement to dietary and regime measures with proven effects on atherogenic serum lipid levels. Pharmacological treatment is generally delayed in young adults, particularly in women who are worried about complications in pregnancy.
However, such an approach is not often appropriate because deferral of effective pharmacological therapy prolongs the period when the vascular walls are exposed to high levels of atherogenic lipoproteins (especially in the LDL class) to produce irreversible atherosclerotic changes. Pharmacological intervention in young patients is targeted primarily at achieving the recommended LDL-cholesterol level, which is the primary therapeutic target.
In patients with mixed DLP we aim to achieve the target value of non-HDL-cholesterol or apolipoprotein B as secondary therapeutic targets. This is also reflected in the choice of pharmacotherapy; we usually start the treatment with statins for which we have evidence of efficacy and long-term safety.
If it is not possible to achieve the monotherapy targets even after titration of the treatment to high intensity (atorvastatin 40 mg per day, rosuvastatin 20-40 mg daily), we choose a combination with ezetimibe. Other options for combination therapy in young adults are based on general recommendations.