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Bempedoic acid, an inhibitor of adenosine triphosphate citrate lyase approved by the FDA in 2020, is a new option for LDL lowering in patients with statin intolerance.
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A novel PCSK9 inhibitor called inclisiran uses silencing RNA technology to reduce PCSK9 protein production by the liver to lower LDL cholesterol. It would enable dosing every 6 months.
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In 2019, the FDA granted icosapent ethyl a broad indication for CVD event lowering in patients with triglycerides over 150 mg/dL and either established CVD or diabetes mellitus plus two or more additional risk factors for CVD.
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In two large pivotal clinical trials, AIM-HIGH and HPS2- THRIVE, extended-release niacin did not reduce cardiovascular events when added to statin therapy in high-risk patients. Therefore, niacin should be used rarely.
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The 2019 European Society of Cardiology guidelines have endorsed an LDL cholesterol treatment goal of less than 55 mg/dL in very high-risk patients.