Established and Emerging Lipid-Lowering Drugs for Primary and Secondary Cardiovascular Prevention.
Level 5 - mechanism / opinion, no new human data
Narrative review of established and emerging lipid-lowering drugs without systematic review methodology or meta-analysis.
PubMed 37486464 · doi:10.1007/s40256-023-00594-5
What was done
A keyword search was conducted to identify literature on established and emerging lipid-modifying pharmaceutical agents for primary and secondary cardiovascular prevention. The authors summarized findings in a narrative review covering mechanisms of action, clinical development status, ongoing trials, adverse effect profiles, lipid impacts, and effects on cardiovascular morbidity and mortality.
What was found
The abstract reports no quantitative estimates or pooled effect sizes. Statins remain the first-line therapy for hypercholesterolemia and hypertriglyceridemia. Established second-line options for secondary prevention include ezetimibe and PCSK9 inhibitors (alirocumab, evolocumab) for hypercholesterolemia, and icosapent ethyl and fenofibrate for hypertriglyceridemia. Novel therapeutic classes encompass small molecules (bempedoic acid, lomitapide, pemafibrate), monoclonal antibodies (evinacumab), antisense oligonucleotides (mipomersen, volanesorsen, pelcarsen, olezarsen), siRNA (inclisiran, olpasiran), and gene therapies targeting pathways such as ANGPTL3, ApoB-100, ApoC-III, and Lp(a). Evidence for add-on therapies in primary cardiovascular prevention remains limited.
Why it matters
This review outlines the shifting paradigm in dyslipidemia management from statin monotherapy toward multi-target molecular therapeutics for residual cardiovascular risk. It emphasizes that while secondary prevention options have expanded, outcome data in primary prevention populations remain an unresolved gap.
Limits
The review is narrative rather than systematic, omitting formal search criteria, study selection flow, quality appraisal, and meta-analytic pooling. Abstract details provide no numeric trial results or patient counts. Emerging therapeutics still require definitive cardiovascular outcome, safety, and cost-effectiveness validation in randomized trials, particularly for primary prevention.
Cited by
- supports Ezetimibe upregulates hepatic LDL receptors by inhibiting intestinal cholesterol reabsorption transporters.