Lipid Lowering Therapy for Atherosclerotic Cardiovascular Disease: It Is Not So Simple

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Lipidology

Background:

• Atherogenic lipoproteins, such as LDL-C, are primary drivers of atherosclerotic cardiovascular disease (ASCVD).
• Current treatments like statins and PCSK9 inhibitors significantly reduce LDL-C but leave residual cardiovascular risk.
• Residual risk is attributed to other atherogenic lipoproteins and non-lipid pathways, including inflammation.

Discussion:

• Statins and PCSK9 inhibitors offer additive benefits through complex mechanisms.
• For statin-intolerant patients, ezetimibe, nutraceuticals, and novel agents are viable options.
• Targeting inflammation and other pathways is key for patients with low LDL-C.

Key Insights:

• No single therapy fully eliminates ASCVD risk; combination approaches are necessary.
• Addressing residual risk requires targeting both lipid and non-lipid pathways.
• Personalized pharmacotherapy will be essential for effective ASCVD management.

Outlook:

• Future ASCVD pharmacotherapy will integrate LDL-C-lowering agents with drugs targeting inflammation, endothelial function, vascular stiffness, and antioxidant activity.
• Development of novel therapeutic strategies is ongoing to comprehensively manage cardiovascular risk.
• A multi-faceted approach combining lipid management with inflammation control promises improved CV outcomes.