Table 1.

Current strategies for lowering the LDL-C level.

Drug	Mechanism of Action	Adverse Effects	References
Ezetimibe	Inhibition of intestine cholesterol absorption	-	[24]
Mipomersen	ApoB synthesis inhibition	Injection site reactions; Influenza-like symptoms; Fatty liver	[61]
Lomitapide	Reduced secretion of apoB-containing lipoproteins by MTP inhibition	Gastrointestinal tract diarrhea, nausea, vomiting, and dyspepsia; Fatty liver	[70,71]
Statins	Reduced hepatic cholesterol synthesis and increased LDLR expression by blocking hepatic 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGR)	Statin-associated muscle symptoms (myalgia, myopathy, and myositis with elevated creatinine kinase rhabdomyolysis)	[62,69]
Anti-PCSK9 monoclonal antibodies (mAbs)	Blockade of circulating PCSK9 interaction with LDLR	Injection site reactions	[63]
Bempedoic acid	Reduced hepatic cholesterol synthesis and increased LDLR expression by blocking ATP-citrate lyase (ACLY)	Elevated uric acid levels; Tendon rupture; Increased serum creatinine	[59]
Bile acid sequestrants	Reduced bile acid reabsorption and increased fecal elimination	Gastrointestinal side effects: constipation, bloating, abdominal discomfort, and aggravation of hemorrhoids	[64,72]
CETP inhibitors	Inhibition of CETP	Increase of plasma aldosterone and blood pressure	[60]
Squalene synthase inhibitors	Reduced hepatic cholesterol synthesis and increased LDLR expression by blocking squalene synthase	Acidosis; Elevation of alanine aminotransferase and total bilirubin	[66,73]
ASBT inhibitors	Reduced bile acid reabsorption	Abdominal pain and diarrhea	[67]