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Beyond Statins

Statins don’t work for everyone. In some cases, a statin by itself won’t lower your low-density lipoprotein (LDL) cholesterol – and in turn your atherosclerotic cardiovascular disease (ASCVD) risk – enough. In other cases, someone might not be able to take a statin. When this happens, other medications – called non-statin therapies – offer more treatment options. Often, a non-statin will be added to a statin.

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 New and emerging lipid-modifying drugs to lower LDL cholesterol

This narrative review aims to provide the current evidence regarding the newly approved LDL-C-lowering therapies as well as the clinical and scientific data pertaining to promising new and emerging lipid-modifying drugs that lower LDL-C.

Articles of Interest

Beyond statins: New ways to lower LDL cholesterol

Fortunately, a number of other LDL-lowering drugs have emerged over the past 20 years. One promising new possibility is enlicitide, a pill version of the powerful LDL-reducing injectable drugs known as PCSK9 inhibitors (see “The gene discovery behind the PCSK9 drugs”).

Cholesterol Lowering Drugs

With currently available drugs to lower LDL-C levels we are now able to markedly reduce LDL-C levels and achieve our LDL-C goals in the vast majority of patients and thereby reduce the risk of cardiovascular disease. Patients with homozygous familial hypercholesterolemia and some patients with heterozygous familial hypercholesterolemia still present major clinical challenges and it can be very difficult in these patients to achieve LDL-C goals.

Lipid-Lowering Agents: Targets Beyond PCSK9

New lipid therapies are needed for individuals with severe dyslipidemias that are refractory to existing treatments, intolerable or harmful adverse effects from existing therapies, or residual ASCVD risk, despite apparently acceptable response to the current standard of care.

Lipid-Lowering Drugs: Statins and Miscellaneous Agents

There are multiple LDL cholesterol lowering therapies available at the moment, including statins, ezetimibe, bempedoic acid, and proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitors. These drugs all have different working mechanisms, but all have shown to lower LDL cholesterol levels and reduce cardiovascular disease.

Lipid-Lowering Medications for Managing Dyslipidemia: A Narrative Review

Statins are the main drug among these medications. Other drugs that are used with statin or as monotherapy include fibrates, omega-3 fatty acids (OM3FAs), ezetimibe, bile acid sequestrants, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, and bempedoic acid.

Medications for Lipid Control: Statins vs Newer Drugs

Although statins are generally well tolerated, certain patients may require dose adjustments or alternative treatments because of side-effects. In patients not achieving adequate lipid control on a maximally tolerated statin, nonstatin medications, including ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, provide enhanced low-density lipoprotein cholesterol reduction and cardiovascular benefits, especially in high-risk patients inadequately managed with statins alone.

Medicines that lower LDL-cholesterol

The most common medications that are used to lower LDL-cholesterol levels are medicines from the STATIN family. These are the medications ending in “ statin” such as atorvastatin or rosuvastatin. Statins work by blocking cholesterol from being made in the liver. Statins are very effective but sometimes people don’t tolerate them or need additional medications to get to the ideal LDL-cholesterol level recommended by their doctor. If you are on a statin and or are unable to take a statin, there are other ways to lower your LDL-cholesterol.

Second-line lipid-lowering agents

Second-line lipid-lowering agents include fibrates, bile acid resins, niacin, and cholesterol absorption inhibitors. These drugs can be used concurrently with statins. for patients who have hypercholesterolemia that is inadequately controlled with statin monotherapy.

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4 statin alternatives that lower cholesterol

Most people have no side effects from statins. However, some people do, most commonly muscle pains and aches. This means they need to take an alternative cholesterol-lowering medicine. And others may need to take another medicine, as well as a statin, to help bring their cholesterol levels down to healthy levels. Here we look at 4 medicines that doctors can prescribe as an alternative, or add-on, to statins.

StatPearls

Lipid-lowering drug therapy plays a central role in reducing the risk of major cardiovascular events such as cardiovascular death, nonfatal myocardial infarction, stroke, coronary revascularization, and unstable angina. These medications are effective for both primary and secondary prevention and are most beneficial when used in conjunction with lifestyle modifications.