Review of LDL-C Lowering with Focus on New and Emerging Agents

LEARNING OBJECTIVES
• Identify the benefits and limitations of statin therapy as a treatment option for lowering LDL-C.
• Intensify treatment in appropriate patients or refer for intensification.
• Describe the safety and efficacy of ezetimibe, bempedoic acid, PCSK9 inhibitors, LDL apheresis.
• Describe the safety and efficacy of medications in late-stage development or under review by the FDA for LDL-C reduction

There is growing consensus that the “LDL Hypothesis” has been proven. First, essentially every well-conducted cardiovascular outcomes trial (CVOT) with low-density lipoprotein cholesterol (LDL-C)-lowering has also shown reduction in atherosclerotic cardiovascular disease (ASCVD). This is true not only for the many CVOTs with statins, but also for at least 5 other classes of medications as well as 3 non-pharmacological treatments.Meta-analyses of these trials show a log-linear relationship between on-treatment LDL-C and ASCVD risk. Further, extensive mechanistic data strongly support a causal role for LDL in atherogenesis. Causation is further supported by several Mendelian randomization studies of a wide variety of genetic conditions, which have consistently reported decreased or increased ASCVD risk related to genetically decreased or increased LDL-C, respectively.
This first section of this review will discuss familial hypercholesterolemia (FH), the most important disease of elevated LDL-C levels, in the context of other causes of LDL-C elevations. Next, it will discuss risk assessment and stratification, relevant to decision-making for LDL-C lowering treatment. Next, LDL-C lowering medications will be covered, beginning with statins, which are by far the best-established agents and which are universally used as first-line treatment for LDL-C lowering and ASCVD prevention. Finally, existing and emerging statin adjuncts will be discussed, regarding their use in management of patients who cannot achieve appropriate LDL-C control with a statin alone.

Post presentation survey link: https://wh1.snapsurveys.com/s.asp?k=159242472033