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Role of Bempedoic Acid in Clinical Practice.
Ballantyne, Christie M; Bays, Harold; Catapano, Alberico L; Goldberg, Anne; Ray, Kausik K; Saseen, Joseph J.
Afiliação
  • Ballantyne CM; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, BCM 285, Houston, TX, 77030, USA. cmb@bcm.edu.
  • Bays H; Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY, USA.
  • Catapano AL; Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Milan, Italy.
  • Goldberg A; Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, MO, USA.
  • Ray KK; Department of Primary Care and Public Health, Imperial College London, London, UK.
  • Saseen JJ; Departments of Clinical Pharmacy and Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Cardiovasc Drugs Ther ; 35(4): 853-864, 2021 08.
Article em En | MEDLINE | ID: mdl-33818688
Many patients do not achieve optimal low-density lipoprotein cholesterol (LDL-C) levels with statins alone; others are unable to tolerate statin therapy. Additional non-statin treatment options including ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and bile acid sequestrants are often necessary to further reduce the risk of atherosclerotic cardiovascular disease. This review provides practical guidance as to the use of bempedoic acid to lower LDL-C and includes direction as to which patients may benefit and advice for safety monitoring during treatment. Bempedoic acid, a new class of agent, is a prodrug converted to bempedoyl-CoA by very long-chain acyl-CoA synthetase 1, an enzyme with high expression in the liver but that is undetectable in the skeletal muscle. Bempedoic acid inhibits the enzyme adenosine triphosphate (ATP)-citrate lyase, which lies two steps upstream from ß-hydroxy ß-methylglutaryl-CoA reductase in the cholesterol biosynthesis pathway. In clinical trials conducted in patients with or at risk for atherosclerotic cardiovascular disease or familial heterozygous hypercholesterolemia, bempedoic acid in combination with statins and/or ezetimibe significantly reduced LDL-C, apolipoprotein B, and high-sensitivity C-reactive protein compared with placebo. Bempedoic acid is generally well tolerated with no clinically meaningful increase in muscle-related symptoms relative to placebo, even in patients taking maximally tolerated statins. A small increase in serum uric acid (mean increase 0.8 mg/dL) is the most noteworthy adverse effect. Bempedoic acid provides an effective and generally well-tolerated medication to further reduce LDL-C in patients taking maximally tolerated statins or manage LDL-C levels in those who are unable to take statins. The potential for a reduced incidence of major cardiovascular events with bempedoic acid is being investigated in the CLEAR Outcomes trial, with results expected in 2023.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Ácidos Dicarboxílicos / Ácidos Graxos / Hipercolesterolemia / LDL-Colesterol Tipo de estudo: Clinical_trials / Guideline Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Ácidos Dicarboxílicos / Ácidos Graxos / Hipercolesterolemia / LDL-Colesterol Tipo de estudo: Clinical_trials / Guideline Limite: Humans Idioma: En Ano de publicação: 2021 Tipo de documento: Article