Abstract
In the prophylaxis of atherothrombotic events, the treatment of dyslipidemia, especially the effort to reduce the high concentration of atherogenic low-density lipoprotein (LDL), plays a key role. With ever-decreasing LDL-cholesterol targets, new innovative approaches need to be introduced.
Statins and ezetimibe are not always sufficient. Monoclonal antibody-based subtilisin-kexin type 9 (PCSK9) proprotein convertase inhibitors are expensive and are reserved for particularly at-risk patients.
Development leads to orally active inhibitors of PCSK9 convertase or to ribonucleic acid (RNA) - inclisirane micro-chains, which inhibit gene transcription and reduce the supply of the PCSK9 isoenzyme itself. Similarly, the effect of more effective and safer inhibition of cholesterol synthesis is being investigated.
Bempedic acid is approved for use, usually in combination with statins. In addition to the LDL lipoprotein itself, the Lp (a) lipoprotein is important.
It accelerates both atherogenesis and increases the risk of thrombotic occlusion by inhibiting fibrinolysis. In the intervention of high concentrations of Lp (a), the efficacy of an oligonucleotide inhibiting the synthesis of apolipoprotein (a) - pelacarsene is examined.
The findings from the first phases of the clinical trial are promising. The last strategy, where significant progress is seen, is treatment to reduce hypertriglyceridemia.
Although current fibrate treatment has reduced triglyceride levels, the effect on the decrease in vascular events has not been convincingly demonstrated. The effectiveness and safety of new procedures are being tested.
These are mainly aimed at increasing lipoprotein lipase activity. However, the question is whether reducing pertriglyceridemia will also improve the prognosis, no convincing evidence has been provided yet.