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Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
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Lipid Lowering Therapy: An Era Beyond Statins.

Toufik Abdul-Rahman1, Syed Muhammad Awais Bukhari2, Emiliano Cantu Herrera3

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Current Problems in Cardiology
|August 2, 2022
PubMed
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.

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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.