Chair, Director-Professor, Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi.
Co-chair, Senior Consultant Cardiologist, Indraprastha Apollo Hospitals, New Delhi, Delhi, India.
J Assoc Physicians India. 2022 Sep;70(9):11-12. doi: 10.5005/japi-11001-0099.
Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
降脂治疗在降低已确诊的动脉粥样硬化性心血管疾病（ASCVD）和家族性高胆固醇血症患者的不良心血管（CV）事件方面起着至关重要的作用。生活方式干预以及高强度他汀类药物治疗是一线管理策略，随后是依折麦布。只有约 20-30%的接受最大耐受他汀类药物治疗的患者达到了推荐的低密度脂蛋白胆固醇（LDL-C）目标。导致该问题的因素包括依从性问题、处方的他汀类药物强度不足、以及他汀类药物剂量降低，但对于基线 LDL-C 水平非常高的患者，包括家族性高胆固醇血症患者和不耐受他汀类药物的患者，扩大 LDL-C 降低药物的武器库至关重要。此外，在根据印度脂质协会（LAI）风险分层算法 LDL-C 目标为≤30mg/dL 的极高风险组患者中，仍存在显著的残余风险，需要添加非他汀类药物来实现 LAI 推荐的目标。这使得贝匹地酸成为依折麦布、胆汁酸螯合剂和 PCSK9 抑制剂等现有非他汀类疗法的一个受欢迎的补充。肌肉相关副作用频率低、药物相互作用最小、高敏 C 反应蛋白（hsCRP）显著降低以及新发或恶化糖尿病的发生率较低，使其成为 LDL-C 降低的有用辅助药物。然而，CV 结局试验结果仍有待确定。在这份 LAI 共识文件中，我们讨论了贝匹地酸的药理学、适应证、禁忌证、优点以及在临床实践中的基于证据的推荐意见。
