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Cardiol Ther. 2019 Jun;8(1):5-20. doi: 10.1007/s40119-018-0123-0. Epub 2018 Dec 12.

Pharmacological Options in Atherosclerosis: A Review of the Existing Evidence.

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Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.
St George's Hospital NHS Trust, London, UK.
Department of Public Health, Sandwell and West Birmingham NHS Trust, Birmingham, UK.


Coronary heart disease (CHD) is the leading cause of mortality worldwide and high low-density lipoprotein (LDL) cholesterol levels have been shown to be key in the pathogenesis of this condition. Lipid control has therefore been the subject of decades of research and has led to many large and robust randomized controlled trials, as well as the highest grossing drug of all time-Lipitor (atorvastatin). Statin therapy has long been indicated for secondary and more recently primary prevention. However, despite the large-scale use of statins, CHD prevalence remains high, and some patients do not respond to statin therapy. There has been a large push to find and test alternative lipid-lowering agents, these include fibrates, cholesterol absorption inhibitors, and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors. It is the aim of this review to assess the literature surrounding each of these groups of drugs.


Cholesterol absorption inhibitor; Fibrates; LDL; Lipid; PCSK-9 inhibitor; Statin

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