27-05-2025
Achieving LDL Cholesterol Goals in Statin-Resistant Patients
High levels of LDL cholesterol (LDL-C) can lead to the development and progression of atherosclerotic cardiovascular disease and increase the risk for major cardiovascular events.
Statins have long been used as first-line therapy to lower LDL-C. However, some patients are unable or unwilling to take statin therapy.
Dr Ann Marie Navar, from the University of Texas Southwestern Medical Center, discusses alternative treatment options for these patients, including the oral medication ezetimibe, which is well tolerated and affordable; however, ezetimibe lowers LDL-C by only 15%-20%.
Dr Navar also discusses newer therapies, including the injectable monoclonal antibody PCSK9 inhibitors evolocumab and alirocumab. Both are dosed about every 2 weeks and have been shown to reduce LDL-C by more than 50% in clinical trials.
Another PCSK9 inhibitor is the first-in-class siRNA inclisiran, a long-acting therapy that is given every 6 months after an initial loading dose that is followed by a second dose at 3 months. Inclisiran is effective at lowering LDL-C, yet clinical data on its cardiovascular outcomes are not yet available.
The final option Dr Navar discusses is the oral therapy bempedoic acid, which is available as monotherapy or combined with ezetimibe as a single pill. The combination lowers LDL-C levels by 35%-40%. As monotherapy, says Dr Navar, bempedoic acid is slightly less effective.
