Novel emerging therapies in atherosclerosis targeting lipid metabolism

Manasvi Gupta, Colin Blumenthal, Subhankar Chatterjee, Dhrubajyoti Bandyopadhyay, Vardhmaan Jain, Carl J. Lavie, Salim S. Virani, Kausik K. Ray, Wilbert S. Aronow, Raktim K. Ghosh

Research output: Contribution to journalReview articlepeer-review

42 Citations (Scopus)

Abstract

Introduction: Recent years have brought significant developments in lipid and atherosclerosis research. Although statins are a cornerstone in hyperlipidemia management, new non-statin therapies have had an impact. The reduction of low-density lipoprotein cholesterol (LDL-C) further translates into the lowering of cardiovascular mortality. Additionally, lipid research has progressed beyond LDL-C reduction and this has brought triglyceride (TG) and other apoprotein-B containing lipids into focus. Areas covered: Inclisiran and pemafibrate, with expected approval soon, come under the spotlight. We discuss other therapeutics such as lomitapide, mipomersen, volanesorsen, and evinacumab and newly approved non-statin-based therapies such as ezetimibe, icosapent ethyl (IPE), and bempedoic acid. Expert Opinion: New options now exist for the prevention of atherosclerosis in patients that are not optimized on statin therapy. Multiple guidelines endorse ezetimibe, PCSK9 inhibitors, bempedoic, and IPE as add-on therapy. Recently approved bempedoic acid/ezetimibe combination might gain popularity among clinicians. Inclisiran and pemafibrate show promise in the reduction of LDL-C and TG, respectively, and results are pending in cardiovascular outcome trials. Combination strategies could improve outcomes, but the challenge will be balancing cost and selecting the correct patient population for each treatment modality to maximize benefit with the fewest medications.

Original languageEnglish
Pages (from-to)611-622
Number of pages12
JournalExpert Opinion on Investigational Drugs
Volume29
Issue number6
DOIs
Publication statusPublished - 2 Jun 2020
Externally publishedYes

Keywords

  • Atherosclerosis
  • CLEAR harmony
  • EVAPORATE
  • FOURIER
  • IMPROVE-IT
  • ODYSSEY
  • ORION-10
  • PCSK9 inhibitors
  • REDUCE-IT
  • bempedoic acid
  • evinacumab
  • inclisiran
  • lomitapide
  • pemafibrate
  • pemfibrate

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