Current Management Guidelines on Hyperlipidemia: The Silent Killer

Table 1

Drugs developed since release of the 2018 ACC/AHA cholesterol guidelines.

Drugs	Mechanism of action	Side effects	Efficacy
Inclisiran [17]	Small interfering RNA targeting hepatic PCSK9 synthesis	Possible myalgia, headache, fatigue, back pain, hypertension, and dizziness	Durable and potent reduction in LDL-C of 51% when used in addition to other lipid-lowering therapies over 17 months of treatment
Evinacumab [18]	Monoclonal antibody that inhibits ANGPTL3	Nasopharyngitis, influenza-like illness, headache, rhinorrhea	At week 24, patients in the Evinacumab group had a 47.1% reduction from baseline in LDL-C levels, as compared to an increase of 1.9% in the placebo group
Vupanorsen [19]	Targets ANGPTL3 with an antisense oligonucleotide	Most common adverse effects were injection site reactions	Statistically significant dose-dependent reductions compared to placebo in ANGPTL3 (62%), VLDL (38%), total cholesterol (19%), and non-HDL (18%)
Gemcabene [20]	Downregulation of hepatic apoC-III mRNA expression and decrease of plasma apoC-III	No severe adverse effects were observed	Gemcabene 300 mg and 900 mg produced a mean percent change in LDL-C of () and (), respectively, vs. for placebo
ARO-ANG3 [21]	siRNA directed against ANGPTL3 mRNA	Headache, respiratory tract infections, and local injection site reactions	Hypercholesterolemia patients on a stable LDL-C-lowering treatment saw a mean maximum reduction in ANGPTL3 of 79-88% and LDL-C of 39-42% after receiving the first dose
Bempedoic acid [22]	Small molecule inhibitor of ATP-citrate lyase	Small elevation in mean uric acid levels	Treatment with Bempedoic acid reduced LDL-C significantly more than placebo at week 12 (placebo-corrected change from baseline, −21.4% (95% CI −25.1% to −17.7%); )