Banach Maciej, Penson Peter E, Farnier Michel, Fras Zlatko, Latkovskis Gustavs, Laufs Ulrich, Paneni Francesco, Parini Paolo, Pirro Matteo, Reiner Željko, Vrablik Michal, Escobar Carlos
Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland; Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Clinical Pharmacy & Therapeutics Research Group, School of Pharmacy & Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool, UK.
Prog Cardiovasc Dis. 2023 Jul-Aug;79:2-11. doi: 10.1016/j.pcad.2023.03.001. Epub 2023 Mar 7.
Cardiovascular disease (CVD) is a chronic non-communicable disease (NCD) and the predominant cause of morbidity and mortality worldwide. Substantial reductions in the CVD prevalence have been achieved in recent years by the attenuation of risk factors (particularly hypertension and dyslipidaemias) in primary and secondary prevention. Despite the remarkable success of lipid lowering treatments, and of statins in particular, in reducing the risk of CVD, there is still an unmet clinical need for the attainment of guideline lipid-targets in even 2/3 of patients. Bempedoic acid, the first in-class inhibitor of ATP-citrate lyase presents a new approach to lipid-lowering therapy. By reducing the endogenous production of cholesterol, upstream of the rate-limiting enzyme HMG-CoA-reductase, i.e., the target of statins, bempedoic acid reduces circulating plasma concentrations of low-density lipoprotein cholesterol (LDL-C), and major adverse CVD events (MACE). Bempedoic acid has the potential to contribute to the reduction of CVD risk not only as monotherapy, but even further as part of a lipid-lowering combination therapy with ezetimibe, reducing LDL-C cholesterol up to 40%. This position paper of the International Lipid Expert Panel (ILEP) summarises the recent evidence around the efficacy and safety of bempedoic acid and presents practical recommendations for its use, which complement the 'lower-is-better-for-longer' approach to lipid management, which is applied across international guidelines for the management of CVD risk. Practical evidence-based guidance is provided relating to the use of bempedoic acid in atherosclerotic CVD, familial hypercholesterolaemia, and statin intolerance. Although there are still no sufficient data avilable for the role of bempedoic acid in the primary prevention of CVD, its favourable effects on plasma glucose and inflammatory markers makes this drug a rational choice in the patient-centred care of specific groups of primary prevention.
心血管疾病（CVD）是一种慢性非传染性疾病（NCD），也是全球发病和死亡的主要原因。近年来，通过在一级和二级预防中减弱危险因素（特别是高血压和血脂异常），心血管疾病的患病率已大幅降低。尽管降脂治疗，尤其是他汀类药物，在降低心血管疾病风险方面取得了显著成功，但仍有三分之二的患者未达到血脂指南目标，存在未满足的临床需求。ATP柠檬酸裂解酶的首个同类抑制剂贝派地酸为降脂治疗提供了一种新方法。通过减少限速酶HMG-CoA还原酶（即他汀类药物的作用靶点）上游的内源性胆固醇生成，贝派地酸降低了循环血浆中低密度脂蛋白胆固醇（LDL-C）的浓度以及主要不良心血管事件（MACE）。贝派地酸不仅作为单一疗法有潜力降低心血管疾病风险，而且作为与依折麦布联合降脂治疗的一部分，进一步降低LDL-C胆固醇达40%。国际脂质专家小组（ILEP）的这份立场文件总结了有关贝派地酸疗效和安全性的最新证据，并提出了其使用的实用建议，这些建议补充了贯穿心血管疾病风险管理国际指南的“长期越低越好”的脂质管理方法。提供了关于贝派地酸在动脉粥样硬化性心血管疾病、家族性高胆固醇血症和他汀类药物不耐受中的使用的基于实际证据的指导。尽管目前尚无足够数据证明贝派地酸在心血管疾病一级预防中的作用，但其对血糖和炎症标志物的有利影响使该药物成为特定一级预防患者群体以患者为中心的护理中的合理选择。
