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Lipid Lowering Therapy for Atherosclerotic Cardiovascular Disease: It Is Not So Simple
Author(s) -
Vincent John
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.1138
Subject(s) - ezetimibe , medicine , residual risk , inflammation , pharmacotherapy , atherosclerotic cardiovascular disease , statin , drug , pharmacology , disease , endocrinology
Plasma levels of atherogenic lipoproteins reflect a key risk factor for atherosclerotic cardiovascular disease ASCVD and treatments that lower these lipoproteins improve CV outcomes. Statins and PCSK9 inhibitors reduce LDL‐C remarkably to low levels but do not eliminate residual cardiovascular risk as a result of other atherogenic lipoproteins or pathways for ASCVD, including inflammation, that are independent of LDL‐C. Statins and PCSK9 inhibitors have complex mechanisms of action which appear to be additive and hence beneficial. Statin‐intolerant subjects may benefit from ezetimibe, combination nutraceuticals and other drugs in development, while subjects with low LDL‐C levels may benefit from anti‐inflammatory drugs that target specific pathways. The future of pharmacotherapy for ASCVD will rely on a combination of drugs that reduce LDL‐C and other atherogenic lipoproteins and drugs that target pathways including inflammation, endothelial function, vascular stiffness and anti‐oxidant activity.