New algorithms for treating homozygous familial hypercholesterolemia
| Autor: | Tycho R. Tromp, Marina Cuchel |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Nutrition and Dietetics
lipid-lowering therapy Endocrinology Diabetes and Metabolism Anticholesteremic Agents Homozygote Cell Biology Cholesterol LDL homozygous familial hypercholesterolemia Hyperlipoproteinemia Type II Receptors LDL cardiovascular disease Genetics Humans Cardiology and Cardiovascular Medicine Molecular Biology Algorithms |
| Zdroj: | Current opinion in lipidology. 33(6):326-335 |
| ISSN: | 0957-9672 |
| Popis: | Purpose of reviewWe reviewed current and future therapeutic options for patients with homozygous familial hypercholesterolemia (HoFH) and place this evidence in context of an adaptable treatment algorithm.Recent findingsLowering LDL-C levels to normal in patients with HoFH is challenging, but a combination of multiple lipid-lowering therapies (LLT) is key. Patients with (near) absence of LDL receptor expression are most severely affected and frequently require regular lipoprotein apheresis on top of combined pharmacologic LLT. Therapies acting independently of the LDL receptor pathway, such as lomitapide and evinacumab, are considered game changers for many patients with HoFH, and may reduce the need for lipoprotein apheresis in future. Liver transplantation is to be considered a treatment option of last resort. Headway is being made in gene therapy strategies, either aiming to permanently replace or knock out key lipid-related genes, with first translational steps into humans being made. Cardiovascular disease risk management beyond LDL-C, such as residual Lp(a) or inflammatory risk, should be evaluated and addressed accordingly in HoFH.SummaryHypercholesterolemia is notoriously difficult to control in most patients with HoFH, but multi-LLT, including newer drugs, allows reduction of LDL-C to levels unimaginable until a few years ago. Cost and availability of these new therapies are important future challenges to be addressed. |
| Databáze: | OpenAIRE |
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