Dyslipidemia, specifically elevated LDL cholesterol levels, causes atherosclerotic cardiovascular disease (ASCVD) and increases the risk of myocardial infarction and stroke. Statins, a class of drugs that exert their effects by inhibiting HMG-CoA reductase, a key enzyme in the synthesis of cholesterol, have been the mainstay of therapy for the primary prevention of cardiovascular disease and lipids reduction. Statins are associated with side effects, most commonly myopathy and myalgias, despite their proven efficacy. This review explores non-statin lipid-lowering therapies and examines recent advances and emerging research. Over the previous decades, several lipid-lowering therapies, both as monotherapy and adjuncts to statin therapy and lipid-targeting gene therapy, have emerged, thus redefining how we treat dyslipidemia. These drugs include Bile acids sequestrants, Fibrates, Nicotinic acid, Ezetimibe, Bempedoic acid, Volanesoren, Evinacumab, and the PCSK 9 Inhibitors Evolocumab and Alirocumab. Emerging gene-based therapy includes Small interfering RNAs, Antisense oligonucleotides, Adeno-associated virus vectors, CRISPR/Cas9 based therapeutics, and Non-coding RNA therapy. Of all these therapies, Bempedoic acid works most like statins by working through a similar pathway to decrease cholesterol levels. However, it is not associated with myopathy. Overall, although statins continue to be the gold standard, non-statin therapies are set to play an increasingly important role in managing dyslipidemia.
Published In/Presented At
Abdul-Rahman T, Bukhari SMA, Herrera EC, Awuah WA, Lawrence J, de Andrade H, Patel N, Shah R, Shaikh R, Capriles CAA, Ulusan S, Ahmad S, Corriero A, Mares AC, Goel A, Hajra A, Bandyopadhyay D, Gupta R. Lipid Lowering Therapy: An Era Beyond Statins. Curr Probl Cardiol. 2022 Jul 30:101342. doi: 10.1016/j.cpcardiol.2022.101342. Epub ahead of print. PMID: 35918009.
Medicine and Health Sciences
Department of Medicine, Cardiology Division, Fellows and Residents