Through the complementary mechanisms of action of inhibition of cholesterol synthesis (bempedoic acid) and inhibition of cholesterol absorption (ezetimibe
), the bempedoic acid / ezetimibe
combination tablet is a non-statin, orally available, once-daily, LDL-C lowering therapeutic candidate, currently under review by the FDA.
Esperion announced positive top-line results from the Phase 2 bempedoic acid / ezetimibe
combination tablet study.
Louis, and colleagues assessed the effect of higher-intensity treatment to lower lipid levels (combination ezetimibe
and simvastatin) to simvastatin monotherapy among patients with stabilized ACS during a median six years of follow-up.
The new guidelines recommend using ezetimibe
or a PCSK9 inhibitor if the goal of 70 mg/dL cannot be achieved with a statin alone.
The update was undertaken because new evidence has emerged since the publication of the 2013 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline about additional cholesterol-lowering agents including ezetimibe
and proprotein convertase sub-tilisin/kexin type 9 (PCSK9) inhibitors.
The others evaluated bempedoic acid as add-on therapy to obtain additional lipid lowering in patients already on a maximum-dose statin, and in combination with ezetimibe
(Zetia) as a single pill, also in patients on full-dose statin therapy.
For patients at elevated risk of heart attack or stroke, adding ezetimibe
(Zetia[R]) to statin therapy can lower LDL an additional 15 to 20 percent.
 Phytosterolaemia responds well to dietary sterol restriction and ezetimibe
but poorly to statin treatment.
(Zetia) to statin therapy lowers this risk even further.
We have provided an application for computers and smartphones to make the diagnosis of FH based on the Simon Broome Registry criteria, the Dutch Lipid Clinics Network criteria, and the new Canadian FH definition (6) that uses an imputed baseline LDL-C if the patient is on lipid-lowering therapy with either statins and/or ezetimibe
. This application can be accessed online (http:// www.circl.ubc.ca/english/web_fh.html) (29).
Fortunately, you probably can reach an LDL below 70 mg/dl by using less expensive oral medications, including high-potency statins--atorvastatin (Lipitor[R]) and rosuvastatin (Crestor[R]) are examples--with or without the cholesterol absorption inhibitor ezetimibe
(Zetia[R]), a recent study suggests.