TY - JOUR
T1 - update aRtICLe Unmet Need for Further LDL-C Lowering in India despite Statin Therapy
T2 - Lipid Association of India Recommendations for the Use of Bempedoic Acid
AU - Mehta, Vimal
AU - Puri, Raman
AU - Duell, P. Barton
AU - Iyengar, S. S.
AU - Wong, Nathan D.
AU - Yusuf, Jamal
AU - Mukhopadhyay, Saibal
AU - Pradhan, Akshaya
AU - Muruganathan, Arumugam
AU - Wangnoo, S. K.
AU - Kapoor, Dheeraj
AU - Rastogi, Ashu
AU - Tiwaskar, Mangesh H.
AU - Mahajan, Kunal
AU - Narasingan, S. N.
AU - Agarwala, Rajeev
AU - Bordoloi, Neil
AU - Soumitra, Kumar
AU - Chakraborty, Rabin
AU - Shetty, Sadanand
AU - Saboo, Bansi
AU - Khan, Aziz
AU - Prabhakar, D.
AU - Khanna, Narendra Nath
AU - Mehta, Ashwani
AU - Bansal, Manish
AU - Kasliwal, Ravi
AU - Mehrotra, Rahul
AU - Chag, Milan
AU - Sheikh, Altamesh
AU - Sattur, Gururaj Balvantrao
AU - Manoria, P. C.
AU - Pareek, K. K.
AU - Pancholia, A. K.
AU - Melinkeri, Rashida Patanwala
AU - Nanda, Rashmi
AU - Kalra, Dinesh
N1 - Publisher Copyright:
© The Author(s). 2022 Open Access This article is distributedunder the terms ofthe Creative Commons Attribution 4.0InternationalLicense (https://creativecommons.org/licenses/by-nc/4.0/). Please refer to the link for more details.
PY - 2022/9
Y1 - 2022/9
N2 - Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
AB - Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
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U2 - 10.5005/japi-11001-0099
DO - 10.5005/japi-11001-0099
M3 - Article
C2 - 36082889
AN - SCOPUS:85137550115
SN - 0004-5772
VL - 70
SP - 67
EP - 75
JO - Journal of Association of Physicians of India
JF - Journal of Association of Physicians of India
IS - 9
ER -