期刊
PROGRESS IN CARDIOVASCULAR DISEASES
卷 79, 期 -, 页码 12-18出版社
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.pcad.2023.02.007
关键词
Lipids; Statins; PCSK9 inhibitors; Ezetimibe; Bempedoic acid; Cardiovascular diseases
Statins are the first-line therapy for dyslipidemia, but many people cannot tolerate them, so alternative medications are needed to lower LDL-C levels and reduce cardiovascular events risk.
Statins are first-line therapy for treating dyslipidemia because of their low-density lipoprotein cholesterol (LDL-C) lowering efficacy, superior event-reduction data and unrivaled cost-effectiveness. Yet, many people are intol-erant of statins, whether due to true adverse events or the nocebo effect, so within one year about two-thirds of primary prevention patients and one-third of secondary prevention patients are no longer taking their prescrip-tion. Statins still dominate this landscape, but other agents, often used in combination, potently reduce LDL-C levels, regress atherosclerosis and lower risk of major adverse cardiovascular events (MACE). Ezetimibe lowers LDL-C by reducing intestinal absorption of cholesterol. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) lower LDL-C by increasing the number and durability of hepatic LDL receptors. Bempedoic acid reduces hepatic cholesterol synthesis. Ezetimibe, PCSK9i and bempedoic are evidence-based, non-statin therapies that synergistically lower LDL-C and reduce risk of MACE; they also have benign side-effect profiles and are generally well tolerated.(c) 2023 Elsevier Inc. All rights reserved.
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