How Will Our Practice Change After the CLEAR Outcomes Trial?

IF 5.7 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Current Atherosclerosis Reports Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI:10.1007/s11883-024-01188-5

Timothy Abrahams, Adam J Nelson, Stephen J Nicholls

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Abstract

Purpose of review: Bempedoic acid is a novel therapeutic agent that is designed to reduce levels of low-density lipoprotein cholesterol (LDL-C). The purpose of this review is to provide the background for development of bempedoic acid, findings from clinical trials and to discuss clinical implications.

Recent findings: Bempedoic acid inhibits ATP citrate lyase within the liver and reduces cholesterol synthesis, with the potential to avoid muscle symptoms experienced by patients treated with statins. Early clinical studies demonstrated that administration of bempedoic acid resulted in lowering of LDL-C by 20-30% as monotherapy and by 40-50% when combined with ezetimibe, in addition to lowering of high sensitivity C-reactive protein by 20-30%. The CLEAR Outcomes trial of high cardiovascular risk patients, with elevated LDL-C levels and either unable or unwilling to take statins demonstrated that bempedoic acid reduced the rate of major adverse cardiovascular events. A greater incidence of elevation of hepatic transaminase and creatinine, gout, and cholelithiasis were consistently observed in bempedoic acid-treated patients. Bempedoic acid presents an additional therapeutic option to achieve more effective lowering of LDL-C levels and reduction in cardiovascular risk.

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CLEAR 成果试验后，我们的实践会有什么变化？

综述目的：本鱼藤酸是一种新型治疗剂，旨在降低低密度脂蛋白胆固醇（LDL-C）的水平。本综述旨在介绍开发仙人掌酸的背景、临床试验结果并讨论其临床意义：鱼腥草酸能抑制肝脏中的 ATP 柠檬酸酶，减少胆固醇的合成，从而有可能避免他汀类药物治疗患者出现的肌肉症状。早期的临床研究表明，单用贝美多克酸可使低密度脂蛋白胆固醇降低 20-30%，与依折麦布联合使用可使低密度脂蛋白胆固醇降低 40-50%，此外还可使高敏 C 反应蛋白降低 20-30%。针对低密度脂蛋白胆固醇（LDL-C）水平升高、无法或不愿服用他汀类药物的高心血管风险患者进行的 CLEAR 结果试验表明，贝门冬氨酸可降低主要不良心血管事件的发生率。在接受过贝美多克酸治疗的患者中，肝转氨酶和肌酐升高、痛风和胆石症的发生率一直较高。鱼腥草酸为更有效地降低低密度脂蛋白胆固醇水平和减少心血管风险提供了另一种治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current Atherosclerosis Reports 医学-

CiteScore

9.00

自引率

3.40%

发文量

审稿时长

6-12 weeks

期刊介绍： The aim of this journal is to systematically provide expert views on current basic science and clinical advances in the field of atherosclerosis and highlight the most important developments likely to transform the field of cardiovascular prevention, diagnosis, and treatment. We accomplish this aim by appointing major authorities to serve as Section Editors who select leading experts from around the world to provide definitive reviews on key topics and papers published in the past year. We also provide supplementary reviews and commentaries from well-known figures in the field. An Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.

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