Related Experiment Video
Updated: Feb 3, 2026
Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
Published on: August 24, 2019
Beyond Statins: Who and When to Prescribe?
1Adult Diabetes and Clinical Research, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA. Om.ganda@joslin.harvard.edu.
Insights
New therapies are needed to further reduce cardiovascular events beyond statins, especially for patients with diabetes and high triglycerides. Promising agents like PCSK9 inhibitors and EPA are showing significant benefits.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Lipid Metabolism
Background:
- Statins are the primary therapy for lowering LDL-cholesterol (LDL-C) to prevent atherosclerotic events.
- Many patients do not achieve sufficient LDL-C reduction with statins alone.
- Residual cardiovascular risk persists due to elevated triglyceride-rich lipoproteins, particularly in diabetic patients.
Purpose of the Study:
- To review current and emerging therapies for cardiovascular risk reduction beyond statins.
- To highlight the need for additional treatments in patients with suboptimal LDL-C control or high triglycerides.
- To discuss novel agents and their potential impact on cardiovascular outcomes.
Main Methods:
- Review of clinical trial data for lipid-lowering agents.
- Analysis of efficacy in reducing LDL-C and cardiovascular events.
- Evaluation of combination therapies with statins.
- Assessment of novel drug development in cardiovascular disease.
Main Results:
- Ezetimibe and PCSK9 inhibitors demonstrate further cardiovascular event reduction beyond statins.
- PCSK9 inhibitors effectively lower LDL-C but not triglycerides.
- The REDUCE-IT trial showed a 25% relative risk reduction with EPA (omega-3 fatty acid).
- Fibrates and niacin have not proven effective in combination with statins.
Conclusions:
- Additional therapies are crucial for managing residual cardiovascular risk.
- PCSK9 inhibitors and EPA represent significant advancements in lipid management.
- Novel agents in development hold promise for improved cardiovascular outcomes.
Purpose Of Review:
Statins are the most evidence-based therapy to target LDL-C to reduce atherosclerotic events. Yet, many people are unable to achieve adequate reduction in this key atherogenic factor. Moreover, residual risk of cardiovascular events may persist even after "optimal" LDL-C due to elevations in triglyceride-rich lipoproteins. Therefore, additional therapies beyond statins are needed, particularly in patients with diabetes.
Recent Findings:
Clinical trials with ezetimibe and PCSK9 inhibitors have reported further reductions in cardiovascular events, beyond statins. The latter are particularly effective in lowering LDL-cholesterol and in reducing event rates. However, they are not effective in lowering triglycerides. Currently available fibrates and niacin have not proven effective in combination with statins in clinical trials, while the top line results of the REDUCE-IT trial with EPA, a pure omega-3 fatty acid, reporting 25% relative risk reduction in primary endpoints are of great interest. Recently approved agents have the promise to improve cardiovascular outcomes beyond statins. Many novel drugs in development have the potential to further improve prognosis.
