TABLE 12.
New lipid-lowering drugs AND Combined application of lipid-lowering drugs.
| New lipid-lowering drugs | |||
|---|---|---|---|
| Name | Lipid lowering target | Main lipid-lowering mechanism | Indication (or proposed approval) |
| Lomitapide | Microsomal triglyceride transfer protein | Reduce VLDL production | ≥18 years old HoFH |
| Mipomersen | ApoB100 | Reduce VLDL production | ≥12 years old HoFH |
| Bempedoic acid | ATP citrate lyase | Facilitate VLDL and LDL metabolism | HeFH, ASCVD |
| Evinacumab | Angiopoietin-like 3 | Facilitate VLDL and LDL metabolism | ≥12 years old HoFH |
| Volanesorsen | ApoC3 | Facilitate CM and VLDL metabolism | ≥18 years old FCS |
| Pelacarsen | Apo(a) | Reduce Lp(a) generation | ASCVD with increased Lp(a) |
| Combined application of lipid-lowering drugs | |||
| Joint strategy a | Applicable situation | Rate of lipid reduction or MACE | Safety concerns |
| Statin + cholesterol absorption inhibitor | LDL-C does not meet the standard with single drug | LDL-C 50%–60% | Routine monitoring |
| Statin + PCSK9 monoclonal antibody | LDL-C does not meet the standard with single drug | LDL-C ≈75% | Routine monitoring |
| Statin + cholesterol absorption inhibitor + PCSK9 monoclonal antibody | LDL-C does not meet the standard with single drug | LDL-C ≈85% | Routine monitoring |
| Statin + high purity IPE 4 g/d | LDL-C meets the standard, TG 2.3–5.7 mmol/L | 25% reduction in MACE risk | Atrial fibrillation, bleeding |
| Statin + fenofibrate or omega-3 fatty acids | LDL-C meets the standard, TG 2.3–5.7 mmol/L | Reduction in MACE risk | Renal function, atrial fibrillation, bleeding |
| Fibrates + omega-3 fatty acid | TG 5.7 mmol/L with single drug | TG 60.8%–71.3% | Routine monitoring |
| Fibrates + niacin analogs | TG 5.7 mmol/L with single drug | Lack of data | Routine monitoring |
| Omega-3 fatty acid + niacin analogs | Fibrates intolerance and TG 5.7 mmol/L with single drug | TG>33% | Routine monitoring |
Statin in the combination strategy refers to medium-intensity statins (see Table 10 for specific types and doses), and “omega-3, fatty acids” refer to medical prescription grade at 4 g/d.
Apo: apolipoprotein; ATP: adenosine triphosphate; VLDL: very low-density lipoprotein; LDL: low-density lipoprotein; CM: chylomicron; Lp(a): lipoprotein(a); HoFH: homozygous familial hypercholesterolemia; HeFH: heterozygous familial hypercholesterolemia; ASCVD: atherosclerotic cardiovascular disease; FCS: familial chylomicronemia syndrome; PCSK9: preprotein convertase chymotrypsin 9; IPE: icosapent ethyl; LDL-C: low-density lipoprotein cholesterol. TG: triglycerides; MACE: major adverse cardiovascular events.