TIMES TO ACT. Italian-Spanish-Polish-Uzbek Expert Forum Position Paper 2022. Dyslipidemia and arterial hypertension: The two most important and modifiable risk factors in clinical practice

Abstract

Hypertension and lipid disorders are two of the main cardiovascular risk factors. Both risk factors - if detected early enough - can be controlled and treated with modern, effective drugs, devoid of significant side effects, available in four countries as different as Italy, Spain, Poland, and Uzbekistan. The aim herein, was to develop this TIMES TO ACT consensus to raise the awareness of the available options of the modern and intensified dyslipidemia and arterial hypertension treatments. The subsequent paragraphs involves consensus and discussion of the deleterious effects of COVID-19 in the cardiovascular field, the high prevalence of hypertension and lipid disorders in our countries and the most important reasons for poor control of these two factors. Subsequently proposed, are currently the most efficient and safe therapeutic options in treating dyslipidemia and arterial hypertension, focusing on the benefits of single-pill combination (SPCs) in both conditions. An accelerated algorithm is proposed to start the treatment with a PCSK9 inhibitor, if the target low-density-lipoprotein values have not been reached. As most patients with hypertension and lipid disorders present with multiple comorbidities, discussed are the possibilities of using new SPCs, combining modern drugs from different therapeutic groups, which mode of action does not confirm the "class effect". We believe our consensus strongly advocates the need to search for patients with cardiovascular risk factors and intensify their lipid-lowering and antihypertensive treatment based on SPCs will improve the control of these two basic cardiovascular risk factors in Italy, Spain, Poland and Uzbekistan.

Keywords: cardiovascular prevention; hypercholesterolemia; hypertension; single-pill combination (SPC).

Figure 1

Comparison of lipid-lowering efficacy of the currently available statins in different doses. The horizontal line shows the 50% low-density lipoprotein (LDL) reduction, required by the latest European guidelines for the treatment of hypercholesterolemia in all patients at high and very high cardiovascular risk (adapted from: [45, 47]).

Figure 2

First model: the three-step algorithm for the treatment of hypercholesterolemia promoted in Europe from 2019; mandatory from 2020 (date of guidelines publication), developed by the European Society of Cardiology (adapted from: [48], modified); Y (yes) — goal achieved; N (no) — goal not achieved; LDL — low-density lipoprotein; PCSK9 — proprotein convertase subtilisin/kexin type 9.

Figure 3

Second model. Accelerated algorithm to start the potential treatment with a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (adapted from: [48], modified); LDL — low-density lipoprotein.

Figure 4

Algorithm to initiate antihypertensive therapy in most patients with arterial hypertension, as recommended in the 2018 guidelines of the European Society of Cardiology (adapted from: [56], modified); ACEI — angiotensin converting enzyme inhibitor; ARB — angiotensin II receptor antagonist; CCB — calcium channel blocker; MRA — mineralcorticoid receptor antagonist.