Lipid lowering in coronary artery disease - not just statins

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Coronary artery disease (CAD) presents significant global morbidity and mortality.
• Effective secondary prevention relies on intensive management of modifiable risk factors, particularly lipid control.
• Current statin therapy alone achieves low-density lipoprotein cholesterol (LDL-c) targets in fewer than 30% of patients.

Purpose of the Study:

• To highlight the importance of non-statin lipid-lowering therapies for secondary prevention in CAD.
• To inform clinicians about available oral and injectable non-statin options.
• To emphasize the role of lipid management in reducing major adverse cardiovascular events (MACE).

Main Methods:

• Review of current evidence and clinical guidelines for lipid management in CAD.
• Identification of established and emerging non-statin pharmacotherapies.
• Discussion of referral criteria for specialized lipid clinics.

Main Results:

• Non-statin therapies, including ezetimibe, bempedoic acid, inclisiran, and PCSK9 inhibitors, are essential additions to statins.
• Icosapent ethyl is indicated for specific patient groups with high triglycerides.
• Future therapies like CETP inhibitors and gene editing are under development.

Conclusions:

• Optimal lipid management, utilizing a range of non-statin therapies, is critical for reducing MACE in CAD patients.
• Clinician awareness of all treatment options, including injectables, is vital for improving patient outcomes in primary and secondary care.
• Timely referral to lipid clinics ensures appropriate patient management and optimization of cardiovascular risk reduction.