A stepwise approach to prescribing novel lipid-lowering medications

Hessam Kakavand, Maryam Aghakouchakzadeh, Ali Shahi, Salim S. Virani, Dave L. Dixon, Benjamin W. Van Tassell, Azita H. Talasaz

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


Dyslipidemia is a major modifiable risk factor for developing atherosclerotic cardiovascular disease. Despite increasing high intensity statin prescription and adherence to statin therapy, a considerable number of patients will not reach the guideline directed goals due to statin intolerance, lack of adherence or treatment efficacy. Several new lipid lowering medications have received approval by regulatory agencies in the past decade including proprotein convertase subtilisin/kexin type 9 modulators, ATP-citrate lyase inhibitors, angiopoietin-like 3 inhibitors, lomitapide, and icosapent ethyl. Although approved by regulatory agencies, these medications are still under-prescribed worldwide which may be related to cost issues, lack of cardiovascular outcome results, or clinicians not being familiar with their use. In this review, we propose a practical stepwise approach including each class’ efficacy, place in therapy, adverse effects, warnings and precautions, and monitoring parameters. This information can help the clinicians to prescribing these novel lipid lowering medications to achieve treatment goals and reduce the risk of atherosclerotic cardiovascular disease. The aim is to shift the paradigm for high-intensity statins from watch and wait to initial combination therapy for high-risk patients.

Original languageEnglish
Pages (from-to)822-832
Number of pages11
JournalJournal of Clinical Lipidology
Issue number6
Publication statusPublished - 1 Nov 2022
Externally publishedYes


  • Bempedoic acid
  • Dyslipidemia
  • Icosapent ethyl
  • Pharmacotherapy
  • pcsk9 inhibitors


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