Drug interactions in cardiology: focus on statins and their combination with other lipid-lowering drugs

Area of Science:

• Pharmacology
• Cardiovascular Medicine
• Drug Interactions

Background:

• Statins are first-line therapy for hypercholesterolemia in high-risk patients per European and American guidelines.
• Some patients require additional lipid-lowering drugs to reach target LDL-C levels.
• Concomitant use of multiple medications increases the risk of adverse events and non-adherence.

Purpose of the Study:

• To provide an update on potential drug-drug interactions (DDIs) between statins and other hypolipidemic drugs.
• To highlight the importance of understanding DDIs for managing hyperlipidemic patients on statin therapy.

Main Methods:

• Review of current European and American guidelines on hyperlipidemia management.
• Analysis of potential DDIs with commonly used second-line hypolipidemic agents (ezetimibe, PCSK9 inhibitors, bempedoic acid, inclisiran).
• Discussion of pharmacokinetic profiles and predictive approaches for DDI assessment.

Main Results:

• The addition of second hypolipidemic drugs to statin therapy can lead to significant drug-drug interactions.
• Specific examples of DDIs with ezetimibe, PCSK9 monoclonal antibodies, bempedoic acid, and inclisiran are discussed.
• Pharmacokinetic evaluations are essential for predicting and managing potential DDIs.

Conclusions:

• Understanding DDIs is fundamental for the safe and effective management of hyperlipidemic patients treated with statins and additional lipid-lowering drugs.
• Existing guidelines for DDI assessment often focus on in vitro studies, necessitating the exploration of new predictive approaches.
• Personalized treatment strategies considering pharmacokinetic profiles can improve patient outcomes and adherence.