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Lipid Lowering Therapy: An Era Beyond Statins
Toufik Abdul-Rahman1, Syed Muhammad Awais Bukhari2, Emiliano Cantu Herrera3
1Sumy State University, Toufik's World Medical Association, Sumy, Sumy Oblast, Ukraine.
Current Problems in Cardiology
|August 2, 2022
Summary
Non-statin therapies offer new options for managing dyslipidemia and lowering low-density lipoprotein (LDL) cholesterol. Bempedoic acid, a statin-like drug, effectively reduces cholesterol without causing myopathy, expanding treatment choices beyond traditional statins.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Genetics
Background:
- Dyslipidemia, characterized by elevated low-density lipoprotein (LDL) cholesterol, is a major risk factor for atherosclerotic cardiovascular disease (ASCVD), myocardial infarction, and stroke.
- Statins, inhibitors of HMG-CoA reductase, are the primary treatment for cardiovascular disease prevention and lipid reduction but can cause side effects like myopathy.
- The need for alternative and adjunct therapies has driven the development of numerous non-statin lipid-lowering treatments.
Purpose of the Study:
- To review current and emerging non-statin lipid-lowering therapies.
- To examine recent advances in gene-based therapies for dyslipidemia.
- To compare the mechanisms and side effect profiles of various lipid-lowering agents.
Main Methods:
- Literature review of non-statin lipid-lowering drugs and gene-based therapies.
- Analysis of therapeutic mechanisms, efficacy, and side effect profiles.
- Comparison of Bempedoic acid with statins regarding cholesterol reduction and myopathy risk.
Main Results:
- Several non-statin classes exist, including Bile acid sequestrants, Fibrates, Nicotinic acid, Ezetimibe, Bempedoic acid, Volanesoren, Evinacumab, and PCSK9 Inhibitors (Evolocumab, Alirocumab).
- Emerging gene-based therapies include Small interfering RNAs, Antisense oligonucleotides, Adeno-associated virus vectors, CRISPR/Cas9, and Non-coding RNA therapies.
- Bempedoic acid effectively lowers cholesterol via a pathway similar to statins but without associated myopathy.
Conclusions:
- While statins remain the standard of care, non-statin therapies are crucial for managing dyslipidemia, especially for patients intolerant to statins.
- The expanding array of lipid-lowering options, including novel gene-based approaches, provides personalized treatment strategies.
- Bempedoic acid represents a significant advancement, offering a statin-like benefit without the common side effect of myopathy.
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