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Évaluation du risque cardiovasculaire en première lignePublished by: Domus MedicaLast published: 2010Cardiovasculaire risicobepaling in de eerste lijnPublished by: Domus MedicaLast published: 2020The likelihood of progression to ischemic cardiomyopathy due to hypercholesterolemia alone depends on other vascular risk factors. Aggressive risk factor control and management of dyslipidemia is recommended.
PVD manifests as insufficient tissue perfusion caused by existing atherosclerosis and chronic narrowing of the vessel lumen, which may be acutely affected by either emboli or thrombi. It is a very common condition that has the potential to cause loss of limb or even loss of life. Aggressive control of all existing risk factors is the mainstay of treatment for chronic PVD.
Long-term lipid-lowering therapy with a statin is recommended for people with acute coronary syndrome. Higher doses are used in patients with acute coronary syndrome because of the role that statins play in plaque stabilization.
An LDL-cholesterol (LDL-C) goal of <70 mg/dL (the European Society of Cardiology/European Atherosclerosis Society guidelines recommend LDL-C <55 mg/dL) and a non-HDL-cholesterol (non-HDL-C) goal of <100 mg/dL are considered a therapeutic option in these high-risk patients.[41][135][136]
In ODYSSEY OUTCOMES, a multicenter, double-blind, randomized controlled trial of 18,924 patients, alirocumab reduced the risk of recurrent ischemic cardiovascular events (including all-cause mortality and myocardial infarction) compared with placebo in patients who had previous acute coronary syndrome and were receiving high-intensity statin therapy.[95][96][104][105]
For patients with thrombotic stroke, the LDL and non-HDL cholesterol (non-HDL-C) goals are defined by the National Cholesterol Education Program as <100 mg/dL and <130 mg/dL, respectively. Patients with a history of ischemic stroke or transient ischemic attack are at very high risk of atherosclerotic cardiovascular disease and should receive intensive lipid-lowering therapy.[41][44]
It has been shown that many patients hospitalized with ischemic stroke or transient ischemic attack have low-density lipoprotein (LDL) levels higher than recommended. Patients at the greatest risk of cardiovascular events are the least likely to be at guideline-recommended LDL levels.[137] Statin therapy has been shown to only modestly reduce stroke recurrence after transient ischemic attack or ischemic stroke. However, important reductions were seen in cardiovascular events.[138]
Endothelial dysfunction is the underlying mechanism of erectile dysfunction, and oxidative stress is associated with elevated levels of low-density lipoprotein.[139] Nonpharmacologic intervention strategies for reducing weight, improving quality of diet, and increasing physical activity can improve erectile function in men at risk.[140]
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