Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Dusseldorf, Dusseldorf, Germany.
Institute for Pharmacology and Clinical Pharmacology, Heinrich Heine University, Dusseldorf, Germany.
Pharmacol Ther. 2020 Sep;213:107592. doi: 10.1016/j.pharmthera.2020.107592. Epub 2020 May 31.
Lipid-lowering therapy is one major cornerstone of medical treatment of cardiovascular disease in order to modulate atherosclerosis. Statins, ezetimibe and novel PCSK9-inhibitors are already recommended in current guidelines and were shown to improve lipid profiles and have positive effects on the rate of ischemic events and cardiovascular mortality. Recent studies suggest that the concept of "The lower the better" might be valid at least regarding low density lipoproteins. In addition, lowering lipoprotein (a) still displays a major challenge in lipid therapy. Furthermore, also lowering triglycerides seems to improve cardiovascular outcome. Regarding triglycerides, icosapent ethyl, a polyunsaturated fatty acid recently attracted attention showing cardiovascular risk reduction due to triglyceride lowering. Therefore, new therapeutic strategies and drug classes are eagerly awaited. Targeting LDL, bempedoic acid and the siRNA inclisiran provide promising results. Moreover, regarding TG a monoclonal antibody called evinacumab and an antisense-oligonucleotide against ANGPTL3 showed effective TG-lowering. At least, using antisense-oligonucleotides against ApoC-III and Lp(a) resulted in promising outcomes. In this review, current and future options for lipid management are presented depending on different drug classes.
降脂治疗是心血管疾病医学治疗的主要基石之一，目的是调节动脉粥样硬化。他汀类药物、依折麦布和新型 PCSK9 抑制剂已被当前指南推荐，并且已证明它们可以改善血脂谱，并对缺血事件发生率和心血管死亡率有积极影响。最近的研究表明，“越低越好”的概念至少在低密度脂蛋白方面可能是有效的。此外，降低脂蛋白(a)仍然是脂质治疗中的一个主要挑战。此外，降低甘油三酯似乎也能改善心血管结局。关于甘油三酯，最近一种多不饱和脂肪酸icosapent ethyl 引起了关注，由于降低甘油三酯，它显示出降低心血管风险的作用。因此，人们急切地期待着新的治疗策略和药物类别。针对 LDL 的 bempedoic 酸和 siRNA inclisiran 提供了有希望的结果。此外，针对 TG 的一种单克隆抗体叫evinacumab 和一种针对 ANGPTL3 的反义寡核苷酸也显示出有效的 TG 降低作用。至少，使用针对 ApoC-III 和 Lp(a) 的反义寡核苷酸也取得了有前景的结果。在这篇综述中，根据不同的药物类别，介绍了当前和未来的脂质管理选择。
