1
|
Mehta V, Puri R, Duell PB, Iyengar SS, Wong ND, Yusuf J, Mukhopadhyay S, Pradhan A, Muruganathan A, Wangnoo SK, Kapoor D, Rastogi A, Tiwaskar MH, Mahajan K, Narasingan SN, Agarwala R, Bordoloi N, Soumitra K, Chakraborty R, Shetty S, Saboo B, Khan A, Prabhakar D, Khanna NN, Mehta A, Bansal M, Kasliwal R, Mehrotra R, Chag M, Sheikh A, Sattur GB, Manoria PC, Pareek KK, Pancholia AK, Melinker RP, Nanda R, Kalra D. Unmet Need for Further LDL-C Lowering in India despite Statin Therapy: Lipid Association of India Recommendations for the Use of Bempedoic Acid. J Assoc Physicians India 2022; 70:11-12. [PMID: 36082889 DOI: 10.5005/japi-11001-0099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lipid-lowering therapy plays a crucial role in reducing adverse cardiovascular (CV) events in patients with established atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia. Lifestyle interventions along with high-intensity statin therapy are the first-line management strategy followed by ezetimibe. Only about 20-30% of patients who are on maximally tolerated statins reach recommended low-density lipoprotein cholesterol (LDL-C) goals. Several factors contribute to the problem, including adherence issues, prescription of less than high-intensity statin therapy, and de-escalation of statin dosages, but in patients with very high baseline LDL-C levels, including those with familial hypercholesterolemia and those who are intolerant to statins, it is critical to expand our arsenal of LDL-C-lowering medications. Moreover, in the extreme risk group of patients with an LDL-C goal of ≤30 mg/dL according to the Lipid Association of India (LAI) risk stratification algorithm, there is a significant residual risk requiring the addition of non-statin drugs to achieve LAI recommended targets. This makes bempedoic acid a welcome addition to the existing non-statin therapies such as ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. A low frequency of muscle-related side effects, minimal drug interactions, a significant reduction in high-sensitivity C-reactive protein (hsCRP), and a lower incidence of new-onset or worsening diabetes make it a useful adjunct for LDL-C lowering. However, the CV outcomes trial results are still pending. In this LAI consensus document, we discuss the pharmacology, indications, contraindications, advantages, and evidence-based recommendations for the use of bempedoic acid in clinical practice.
Collapse
Affiliation(s)
- Vimal Mehta
- Chair, Director-Professor, Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi
| | - Raman Puri
- Co-chair, Senior Consultant Cardiologist, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - P Barton Duell
- Co-chair, Professor of Medicine and Director, Cardiovascular Institute and Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health & Science University, Portland, Oregon, USA
| | - S S Iyengar
- Sr. Consultant, Department of Cardiology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Nathan D Wong
- Professor and Director, Heart Disease Prevention Program Division of Cardiology, University of California Irvine, Irvine, California, USA
| | | | - Saibal Mukhopadhyay
- Director-Professor and Head, Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, Delhi
| | - Akshaya Pradhan
- Sr. Consultant, Department of Cardiology, King George's Medical University, Lucknow, Uttar Pradesh
| | | | - S K Wangnoo
- Sr. Consultant Endocrinologist & Diabetologist, Indraprastha Apollo Hospitals, New Delhi, Delhi
| | - Dheeraj Kapoor
- Head, Department of Endocrinology, Artemis Hospital, Gurugram, Haryana
| | - Ashu Rastogi
- Assistant Professor, Department of Endocrinology and Metabolism, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab
| | - Mangesh H Tiwaskar
- Consultant Physician and Dialectologist, Shilpa Medical Research Centre, Mumbai, Maharashtra
| | - Kunal Mahajan
- Assistant Professor, Department of Cardiology, Indira Gandhi Medical College & Hospital, Shimla, Himachal Pradesh
| | - S N Narasingan
- Former Adjunct Professor, Department of Medicine, The Tamil Nadu Dr. M.G.R. Medical University; Managing Director, SNN Specialities Clinic, Chennai, Tamil Nadu
| | - Rajeev Agarwala
- Sr. Consultant Cardiologist, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh
| | - Neil Bordoloi
- Managing Director and HOD, Department of Cardiology, Excelcare Hospitals, Guwahati, Assam
| | - Kumar Soumitra
- Professor and Head, Department of Cardiology, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal
| | - Rabin Chakraborty
- Consultant Cardiologist, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute; Director, Centre for Cardiac Sciences
| | - Sadanand Shetty
- Head, Department of Cardiology, KJ Somaiya Hospital Super Speciality Center, Mumbai, Maharashtra
| | - Bansi Saboo
- Chief Diabetologist & Chairman, Dia-Care Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat
| | - Aziz Khan
- Sr. Consultant Cardiologist, Crescent Hospital & Heart Centre, Nagpur, Maharashtra
| | - D Prabhakar
- Sr. Consultant, Department of Cardiology, Apollo Hospitals, Chennai, Tamil Nadu
| | | | - Ashwani Mehta
- Sr. Consultant Cardiologist, Sir Ganga Ram Hospital, New Delhi, Delhi
| | | | - Ravi Kasliwal
- Chairman, Division of Clinical & Preventive Cardiology, Medanta Hospital, Gurugram, Haryana
| | - Rahul Mehrotra
- Director & Head, Department of Non-invasive Cardiology, Max Super Speciality Hospital, New Delhi, Delhi
| | - Milan Chag
- Interventional Cardiologist & Managing Director, Marengo CIMS, Ahmedabad, Gujarat
| | - Altamesh Sheikh
- Sr. Consultant, Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra
| | | | - P C Manoria
- Director, Manoria Heart and Critical Care Hospital, Bhopal, Madhya Pradesh
| | - K K Pareek
- Head, Department of Medicine, S. N. Pareek Hospital, Kota, Rajasthan
| | - A K Pancholia
- Head of Department, Department of Medicine & Preventive Cardiology, Arihant Hospital & Research Centre, Indore, Madhya Pradesh
| | | | - Rashmi Nanda
- Consultant Physician, Cardiac Care Centre, New Delhi, Delhi, India
| | - Dinesh Kalra
- Associate Professor, Department of Medicine, Rush Medical College, Rush Medical College, USA
| |
Collapse
|