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Inter-Individual Variability in Lipid Response: A Narrative Review

      Abstract

      Lipid-lowering guidelines emphasize shared-decision making between clinicians and patients, resulting in patients anticipating the degree of response from diet and/or drug therapy. Challenging for physicians are understanding the sources of variability complicating their management decisions include non-adherence, genetic considerations, additional lipid parameters including Lipoprotein (a) levels (Lp(a)), and rare systemic responses limiting benefits that result in non-responsiveness to monoclonal antibody injection. In this narrative review, we focus on the variability of LDL-C response to guideline directed interventions such as statins, ezetimibe, bile acid sequestrants, fibrates, PCSK9 inhibitors and LDL-C lowering diets. We hypothesize that the variability in individual lipid responses is multifactorial. We provide an illustrative model with a check list that can be used to identify factors that may be present in the individual patient.

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