Key result
Novel lipid-lowering therapies beyond statin monotherapy optimize LDL-C control and lower ASCVD risk.
Why the study?
Many patients at very high ASCVD risk or with familial hypercholesterolemia fail to reach target LDL-C levels on statin monotherapy, while novel lipid-lowering therapies remain underutilized.
Novel lipid-lowering therapies provide crucial new management options for patients unable to achieve LDL-C targets with statin monotherapy.
Reducing low-density lipoprotein cholesterol (LDL-C) levels is crucial to the prevention of atherosclerotic cardiovascular disease (ASCVD). However, many patients, especially those at very high ASCVD risk or with familial hypercholesterolemia (FH), do not achieve target LDL-C levels with statin monotherapy. The underutilization of novel lipid-lowering therapies (LLT) globally may be due to cost concerns or therapeutic inertia. Emerging approaches have the potential to lower LDL-C and reduce ASCVD risk further, in addition to offering alternatives for statin-intolerant patients. Shifting the treatment paradigm towards initial combination therapy and utilizing novel LLT strategies can complement existing treatments. This review discusses innovative approaches including combination therapies involving statins and agents like ezetimibe, bempedoic acid, cholesterol ester transfer protein (CETP) inhibitors as well as strategies targeting proprotein convertase subtilisin/kexin type 9 (PCSK9) and angiopoietin-like protein 3 (ANGPTL3) inhibition. Advances in nucleic acid-based therapies and gene editing are innovative approaches that will improve patient compliance and adherence. These strategies demonstrate significant LDL-C reductions and improved cardiovascular outcomes, offering potential for optimal LDL-C control and reduced ASCVD risk. By addressing the limitations of statin monotherapy, these approaches provide new management options for elevated LDL-C levels.
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Mohamed et al. (2023) conducted a review in Elevated low-density lipoprotein cholesterol and atherosclerotic cardiovascular disease. Novel lipid-lowering therapies (PCSK9 inhibitors, ANGPTL3 inhibitors, bempedoic acid, gene editing) was evaluated. Emerging lipid-lowering strategies, including combination therapies and agents targeting PCSK9 and ANGPTL3, offer significant potential for optimal LDL-C control and reduced ASCVD risk beyond statin monotherapy.
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