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Beyond Statins: Who and When to Prescribe?

  • Macrovascular Complications in Diabetes (VR Aroda and A Getaneh, Section Editors)
  • Published:
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Abstract

Purpose of Review

Statins are the most evidence-based therapy to target LDL-C to reduce atherosclerotic events. Yet, many people are unable to achieve adequate reduction in this key atherogenic factor. Moreover, residual risk of cardiovascular events may persist even after “optimal” LDL-C due to elevations in triglyceride-rich lipoproteins. Therefore, additional therapies beyond statins are needed, particularly in patients with diabetes.

Recent Findings

Clinical trials with ezetimibe and PCSK9 inhibitors have reported further reductions in cardiovascular events, beyond statins. The latter are particularly effective in lowering LDL-cholesterol and in reducing event rates. However, they are not effective in lowering triglycerides. Currently available fibrates and niacin have not proven effective in combination with statins in clinical trials, while the top line results of the REDUCE-IT trial with EPA, a pure omega-3 fatty acid, reporting 25% relative risk reduction in primary endpoints are of great interest.

Summary

Recently approved agents have the promise to improve cardiovascular outcomes beyond statins. Many novel drugs in development have the potential to further improve prognosis.

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Funding

The author was supported, in part, by NIDDK grant no. P30-DK036836.

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  1. Adult Diabetes and Clinical Research, Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA, 02215, USA

    Om Ganda

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Om Ganda reports grants from Amarin Pharma and personal fees from Sanofi-Regeneron and Akcea.

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This article is part of the Topical Collection on Macrovascular Complications in Diabetes

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Ganda, O. Beyond Statins: Who and When to Prescribe?. Curr Diab Rep 18, 126 (2018). https://doi.org/10.1007/s11892-018-1087-0

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