Scheen A J, Paquot N, Wallemacq C
Service de Diabétologie, Nutrition et Maladies métaboliques , CHU Liège, Belgique.
Rev Med Liege. 2022 Feb;77(2):124-131.
Patients at high or very high cardiovascular risk should have a LDL cholesterol level as low as possible, a target that may be difficult to be reached with statin monotherapy, especially when this treatment is not well tolerated. It is generally recommended to use pharmacological combinations to reach more and more strict objectives. Bempedoic acid is a new oral cholesterol-lowering medication that reduces hepatic cholesterol synthesis by inhibiting the enzyme adenosine triphosphate (ATP)-citrate lyase enzyme. Because this medication is a prodrug that is selectively activated in the liver, it is deprived of any muscular adverse effect. This article summarizes the mode of action, pharmacokinetics, efficacy, safety profile, indications and reimbursement conditions of bempedoic acid. This novel cholesterol-lowering drug is indicated in combination with statins (with or without ezetimibe) in patients who do not attain LDL goals despite administration of a statin at the maximum tolerated dose or in case of statin intolerance.
心血管风险高或极高的患者应将低密度脂蛋白胆固醇水平降至尽可能低的水平，而仅使用他汀类药物单药治疗可能难以实现这一目标，尤其是当这种治疗耐受性不佳时。一般建议使用药物联合治疗以实现越来越严格的目标。贝派地酸是一种新型口服降胆固醇药物，它通过抑制三磷酸腺苷（ATP）-柠檬酸裂解酶来减少肝脏胆固醇合成。由于这种药物是一种前体药物，在肝脏中被选择性激活，因此没有任何肌肉不良反应。本文总结了贝派地酸的作用方式、药代动力学、疗效、安全性、适应症和报销条件。这种新型降胆固醇药物适用于尽管已给予最大耐受剂量的他汀类药物但仍未达到低密度脂蛋白目标的患者，或在他汀类药物不耐受的情况下，与他汀类药物（联合或不联合依折麦布）联合使用。
