Comprehensive review of statin-intolerance and the practical application of Bempedoic Acid.
J Cardiol
; 84(1): 22-29, 2024 Jul.
Article
em En
| MEDLINE
| ID: mdl-38521120
ABSTRACT
Statin-intolerance (SI) has prevalence between 8.0â¯% and 10â¯%, and muscular complaints are the most common reason for discontinuation. Bempedoic acid (BA), an ATP citrate lyase inhibitor, decreases hepatic generation of cholesterol, upregulates low-density lipoprotein (LDL) receptor expression in the liver, and eventually clears circulating LDL-cholesterol from the blood. Multiple randomized clinical trials studying BA demonstrate a reduction in LDL levels by 17-28â¯% in SI. The CLEAR OUTCOME trial established significant cardiovascular benefits with BA. A dose of 180â¯mg/day of BA showed promising results. BA alone or in combination with ezetimibe is US Food and Drug Administration-approved for use in adults with heterozygous familial hypercholesterolemia and/or established atherosclerotic cardiovascular disease. BA reduced HbA1c by 0.12â¯% (pâ¯<â¯0.0001) in patients with diabetes. Adverse events of BA include myalgia (4.7â¯%), anemia (3.4â¯%), and increased aminotransferases (0.3â¯%). BA can cause up to four times higher risk of gout in those with a previous gout diagnosis or high serum uric acid levels. Reports of increased blood urea nitrogen and serum creatinine were noted. Current evidence does not demonstrate a reduction in deaths from cardiovascular causes. More studies that include a diverse population and patients with both high and low LDL levels should be conducted. We recommend that providers consider BA as an adjunct to statin therapy in patients with a maximally tolerated dosage to specifically target LDL levels.
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Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Inibidores de Hidroximetilglutaril-CoA Redutases
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Ácidos Dicarboxílicos
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Ácidos Graxos
Limite:
Humans
Idioma:
En
Revista:
J Cardiol
Ano de publicação:
2024
Tipo de documento:
Article