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Pharmacological lipid-modification therapies for prevention of ischaemic heart disease: current and future options

Kausik K Ray1, Pablo Corral2, Enrique Morales3

  • 1Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK.

Lancet (London, England)
|August 27, 2019
PubMed

Insights

New therapies complement statins for managing high cholesterol and reducing heart disease risk. This review covers emerging treatments targeting LDL cholesterol, lipoprotein(a), and triglycerides.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Metabolic Diseases

Background:

  • Atherosclerosis and ischemic heart disease represent a significant global health challenge.
  • Prevention necessitates a multifactorial approach, including lifestyle modifications and management of cardiovascular risk factors like hypertension and dyslipidemia.
  • Low-density lipoprotein (LDL) cholesterol is a primary target for intervention, with statins as first-line therapy.

Purpose of the Study:

  • To review current and emerging pharmacological therapies for lowering LDL cholesterol, lipoprotein(a), and triglycerides.
  • To provide an overview of treatments for the prevention of ischemic heart disease.
  • To discuss alternative and additional therapies for patients unable to tolerate statins or requiring further LDL cholesterol reduction.

Main Methods:

  • Literature review of available and emerging therapies for lipid modification.
  • Analysis of clinical trial data for novel lipid-lowering agents.
  • Inclusion of evidence supporting the role of lipoprotein(a) and triglycerides in ischemic heart disease.

Main Results:

  • Statins are the cornerstone of pharmacological LDL cholesterol reduction.
  • Emerging therapies include ezetimibe, PCSK9 inhibitors, bempedoic acid, and inclisiran, targeting various pathways of cholesterol metabolism.
  • Emerging evidence highlights the causal role of elevated lipoprotein(a) and triglycerides in ischemic heart disease.

Conclusions:

  • A range of pharmacological options exist beyond statins to manage dyslipidemia and prevent ischemic heart disease.
  • Novel therapeutics offer new avenues for further lowering LDL cholesterol and addressing other atherogenic lipoproteins.
  • Comprehensive management strategies targeting multiple lipid parameters are crucial for cardiovascular risk reduction.

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