Lipid Lowering Drugs

Abstract

Fat is an important nutrient in our diets. The adverse cardiovascular events as a result of elevated levels of lipoproteins in the blood led to the concept of lipid-lowering medications. Non-statin agents such as niacin, fibrates, fish oils, and ezetimibe are well known as lipid-lowering agents. In various clinical trials such as WOSCOPS (West of Scotland Coronary Prevention Study), JUPITER (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin), and other trials, the concept of lowering of cholesterol-containing apolipoprotein B lipoproteins was achieved by 3-hydroxy-3-methylglutaryl-coenzyme A (HMG Co A) reductase inhibitors or statins. Statins lower the LDL-C and thereby reduce cardiovascular morbidity and mortality. Many patients may not achieve their target levels of LDL-C, and as a result, there remains an LDL-associated residual risk. Loss-of-function mutations of the PCSK9 gene discovered were linked to low plasma LDL-C levels and a reduction of cardiovascular risk. In November of 2013, the American College of Cardiology (ACC) and American Heart Association (AHA) released four new guidelines such as Guideline on Risk Assessment, Guideline on Managing Blood Cholesterol, Guideline on Lifestyle Management, and Guideline for the Management of Overweight and Obesity which deal with the prevention of CVD by better assessing risk and by managing cholesterol, lifestyle, and weight. The central role of proprotein convertase subtilisin/kexin type 9 in the regulation of cholesterol homeostasis by increasing the endosomal and lysosomal degradation of hepatic LDLR (low-density lipoprotein receptor) has now been identified. Loss-of-function mutations of PCSK9 gene were reported to be linked to low plasma LDL-C levels and marked reduction of cardiovascular risk.