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Treatment Strategies for Drug-Resistant Hyperlipidemia, Part 2
What side effects and risks are associated with medications for lowering LDL cholesterol? Can those risks be avoided?
Dr. Pradeep Natarajan, MD, MMSc, identifies the side effects for major LDL-C-lowering strategies as well as strategies to mitigate the risks. First-line therapies including statins and ezetimibe are discussed as well as considerations for pursuing non-statin medications such as bempodoic acid, PCSK9 mAbs, and PCSK9 siRNAs to lower LDL-C.
00:00 | Introduction
00:27 | Side effects of statin
02:50 | Minimizing statin-associated side effects
04:16 | The relationship between statins and diabetes
05:03 | Key considerations for novel non-statin agents
This video was peer reviewed by Dr. Jonathan Salik, TMD, MHPEd, Instructor of Medicine, Massachusetts General Hospital; and Dr. Sugantha Sundar, MD, Assistant Professor of Anesthesia, Beth Israel Deaconess Medical Center, to validate the quality and accuracy of the content.
References:
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Preiss D, Tobert JA, Hovingh GK, Reith C. Lipid-Modifying Agents, From Statins to PCSK9 Inhibitors: JACC Focus Seminar. J Am Coll Cardiol. 2020;75(16):1945-1955. doi:10.1016/j.jacc.2019.11.072
Emerging Risk Factors Collaboration, Di Angelantonio E, Sarwar N, et al. Major lipids, apolipoproteins and risk of vascular disease. JAMA. 2009;302(18):1993-2000. doi:10.1001/jama.2009.1619
Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-2472. doi:10.1093/eurheartj/ehx144
Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372(25):2387-2397. doi:10.1056/NEJMoa1410489
Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med. 2017;376(18):1713-1722. doi:10.1056/NEJMoa1615664
Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. N Engl J Med. 2018;379(22):2097-2107. doi:10.1056/NEJMoa1801174
Goldberg AC, Leiter LA, Stroes ESG, et al. Effect of Bempedoic Acid vs. Placebo Added to Maximally Tolerated Statins on Low-Density Lipoprotein Cholesterol in Patients at High Risk for Cardiovascular Disease: The CLEAR Wisdom Randomized Clinical Trial [published correction appears in JAMA. 2020 Jan 21;323(3):282]. JAMA. 2019;322(18):1780-1788. doi:10.1001/jama.2019.16585
Ray KK, Wright RS, Kallend D, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;382(16):1507-1519. doi:10.1056/NEJMoa1912387
Kashani A, Phillips CO, Foody JM, et al. Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation. 2006;114(25):2788-2797. doi:10.1161/CIRCULATIONAHA.106.624890
Riaz H, Khan AR, Khan MS, et al. Meta-analysis of Placebo-Controlled Randomized Controlled Trials on the Prevalence of Statin Intolerance. Am J Cardiol. 2017;120(5):774-781. doi:10.1016/j.amjcard.2017.05.046
Gupta A, Thompson D, Whitehouse A, et al. Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomized, double-blind placebo-controlled trial and its non-randomized non-blind extension phase. Lancet. 2017;389(10088):2473-2481. doi:10.1016/S0140-6736(17)31075-9
Björnsson E, Jacobsen EI, Kalaitzakis E. Hepatotoxicity associated with statins: reports of idiosyncratic liver injury post-marketing. J Hepatol. 2012;56(2):374-380. doi:10.1016/j.jhep.2011.07.023
Swerdlow DI, Preiss D, Kuchenbaecker KB, et al. HMG-coenzyme A reductase inhibition, type 2 diabetes, and bodyweight: evidence from genetic analysis and randomized trials. Lancet. 2015;385(9965):351-361. doi:10.1016/S0140-6736(14)61183-1
Notice: At this time, the content in this video is not accredited.
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