New Lipid-lowering Drugs

• LDL-C is universally accepted as a major driver of atherosclerosis. Higher the baseline LDL, the higher the risk.

• Low and very low LDL levels are safe/effective in reducing CV events further, as shown by PCSK9 trials. Target LDL-C must be achieved in all patients with ASCVD.

• Lifestyle interventions remain the mainstay of management.

• High-dose statin is the first-line of therapy. Add ezetimibe in patients, not on goal. Either alone or in combination with statins, PCSK9 inhibitors reduce LDL by 60%.

• Bempedoic acid may be added if LDL-C reduction is required after statins and ezetimibe. PCSK9 inhibitor is indicated in selected patients.