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Treatment of High LDL Cholesterol

There remains controversy about the efficacy of omega-3 therapies, since the 2020 STRENGTH trial showed no CVD benefit of omega-3 carboxylic acids; it remains unclear if this result was due to a different omega-3 fatty acid preparation, chance, or a much smaller benefit of omega-3 fatty acids preparations than originally demonstrated.

Bempedoic acid lowers LDL approximately 17–20% on top of moderate to high intensity statins. Similar to statins, bempedoic acid targets cholesterol synthesis in the liver; bempedoic acid inhibits adenosine triphosphate citrate lyase, an enzyme that is upstream of the mechanism of statins (inhibition of HMG-CoA reductase).

Bempedoic acid is also marketed in combination with ezetimibe; this combination provides approximately 38% LDL reduction on top of background lipid-lowering therapy.

Treatment with bempedoic acid may mildly decrease both high sensitivity C-reactive protein (hsCRP) and the risk of diabetes.

Bemepdoic acid also appears to modestly increase the risk of tendon rupture.

Bemepdoic acid should not be used with more than 20 mg of simvastatin daily or 40 mg of pravastatin daily.

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