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. 2022 Dec 19;13:100451. doi: 10.1016/j.ajpc.2022.100451

Table 3.

Summary of Lipid Lowering Therapies: dosing, side effects, lipids, and cardiovascular outcomes reduction.

Category Dosing Potential Side effects Usual Lipid reduction CVD outcomes reduction
Statins
Atorvastatin Rosuvastatin Simvastatin Pravastatin Pitavastatin Lovastatin Fluvastatin		 High intensity: Atorva 40–80 and Rosuva 20–40 mg
Low/Moderate intensity:
Atorva 10–20 mg; Rosu 5–10mg; Simva 10–40mg; Fluva 20–80 mg; Lova 20–80 mg, Pitava 1–4 mg, Prava 10–80 mg
  • -

    Myalgias, myopathy

  • -

    Dyspepsia

  • -

    Myonecrosis, Rhabdomyolysis

  • -

    Transaminase elevation

  • -

    Increased risk of new-onset diabetes

 High intensity: >50%

Moderate intensity: 30–49%

Low intensity: <30%		 Primary prevention
JUPITER (Rosu) [101]
HR: 0.56 (0.46–0.69)

WOSCOPS (Simva) [102]
HR: 0.69 (0.57–0.83)

CARDS (Atorva) [103]
HR: 0.65 (0.30 to 1.55)
Cholesterol absorption inhibitors
Ezetimibe		 10 mg daily
  • -

    Diarrhea

  • -

    Back pain

  • -

    Abdominal pain

  • -

    Muscle pains

 LDL-C reduction of 15–20% as monotherapy.
Combined with statin, there is a 25% extra reduction.		 Primary prevention
EWTOPIA 75 [104]
HR: 0.66 (0.50–0.86)

SHARP [105]
HR: 0.83 (0.74–0.94)
PCSK9
Inhibitors
Evolocumab Alirocumab		 Alirocumab: dosed 75–150mg q 2 weeks or 300 mg q 4 weeks

Evolocumab 140 mg
q 2 weeks or 420mg q 4 weeks
  • -

    Injection site reactions

  • -

    Nasopharyngitis

  • -

    Back pain

  • -

    New onset diabetes

 LDL-C reduction of 40–65% when added on to statin and/or ezetimibe
Mean LDL-C decrease is 30% with evolocumab in patients with HoFH		 Secondary prevention
FOURIER [106]
HR: 0.85 (0.79–0.92)

ODYSSEY [107]
HR: 0.85 (0.78–0.93)
Bile Acid Sequestrants
Colesevelam
Cholestyramine Colestipol		 Colesevelam: 3.75gr daily or 1.87 gr twice a day
Cholestyramine: 8–16 g/day orally
Colestipol: 2–16 g/day orally
  • -

    Constipation, upset stomach

  • -

    Triglyceride elevation

  • -

    May bind other medications (Thiazides, Warfarin, Aspirin)

 Typically lowers LDL-C by 15–20% Primary prevention
LRC (Cholestyramine) [108]
HR: 0.83 (0.09 to 1.37)
Bempedoic Acid 180 mg oral daily
  • -

    Hyperuricemia

  • -

    Tendon rupture

  • -

    Back pain

  • -

    Anemia

 Lowers LDL-C by -19%
In combination with Ezetimibe by -38%		 No outcomes trial

CLEAR – Safety trial [109]
Inclisiran 284 mg SQ q 3months
  • -

    Injection site reactions

  • -

    Transaminase elevation

  • -

    Arthralgia

 Lowers LDL-C by -50% No outcomes trial

ORION-9 – LDL reduction [110]
n-3 Fatty Acids
Omega-3-acid ethyl esters (Lovaza)

Icosapent ethyl (Vascepa)		 Lovaza 4 g/day
Vascepa 4 g/day
  • -

    Fishy taste in mouth

  • -

    May prolong bleeding time

 Neutral effect on LDL-C lowering
TG lowering of 20–30%		 Secondary prevention
REDUCE-IT (Icosapent ethyl) [111]
HR: 0.75 (0.68–0.83)

ORIGIN (Ethyl esters) [112]
HR: 0.98 (0.87–1.10)
Fibrates
Fenofibrate Gemfibrozil		 Fenofibrate 50–160 mg/day
Gemfibrozil 600 mg twice daily
  • -

    Myositis

  • -

    Cholelithiasis

 TG lowering of 40–50%
Lowers LDL-C by 30%		 Secondary prevention
ACCORD [113]
HR: 0.92 (0.79–1.08)
Niacin 500 to 2000 mg/day
  • -

    Flushing, Pruritus

  • -

    Hepatitis

  • -

    Gout

 TG lowering of 15–25%
LDL-C 10–20%;		 Secondary prevention
Systematic Review [114]
RR 0.99; 95% CI 0.88–1.12)

CVD: cardiovascular disease. HoFH: Homozygous familial hypercholesterolemia, HR: hazard ratio, LDL-C: low-density lipoprotein cholesterol, RR: relative risk.