Page 31 - GALENIKA MEDICAL JOURNAL

Table 2. Therapeutic strategies for treating dyslipidemia and mechanism of action of lipid-lowering drugs
The name of Dosage regimen and mode of
the medication Mechanism of action Target lipoproteins Indications administration
HMG-3-CoA TC; LDL-h;
Statins Primary and secondary dyslipidemias 1 x daily p.o.
reductase inhibitor Apo B; TG
PPARα TG; Hypertriglyceridemia;
Fibrates 1 x daily p.o.
agonist VLDL; LDL-h Familial combined hyperlipidemia
ACL LDL-h; FH;
Bempedoic acid 1 x daily p.o.
inhibitor Apo B; Non-HDL-h Familial combined hyperlipidemia
NPC1L1 FH;
Ezetimibe TC; LDL-h; TG 1 x daily p.o.
transporter inhibitor Familial combined hyperlipidemia
Primary hypercholesterolemia;
Evolocumab PCSK9 LDL-h;Apo B; Familial combined hyperlipidemia 1-2 x monthly s.c.
Alirocumab monoclonal antibody inhibitor Non-HDL-h; Lp (a)
HeFH; HoFH
Primary hypercholesterolemia;
PCSK9 siRNA- LDL-h; Apo B;
Inclisiran Familial combined hyperlipidemia; 1 x in 6 month s.c.
small interfering ribonucleic acid Non-HDL-h; Lp (a); TG
HeFH; HoFH
ANGPTL3
Evinacumab LDL-h; Apo B; Non-HDL-h; TG HoFH 1 x a month i.v.
monoclonal antibody inhibitor
Apo (A)
Pelacarsen LDL-h; Lp (a); Apo B Not approved 1 x a month s.c.
translation blocker
Inhibitor of
Olpasiran Lp (a) Not approved 1 x in 3 months s.c.
iRNK translation for Lp(a)
Apo C-III; TG; Hypertriglyceridemia;
Volanesorsen Apo C-III inhibitor 1 x weekly s.c.
Chylomicrons Hyperchylomicronemia
Apo C-III; TG;
Olezarsen Apo C-III inhibitor Not approved 1 x a week s.c.
Chylomicrons
Legend: TC - Total Cholesterol; LDL-h - Low density lipoprotein; TG - Triglycerides; Apo - Apolipoprotein; Lp (a) – lipoprotein (a); Non-HDL-h - Non-HDL-holesterol; ACL - Adenosine trip-
hosphate-Citrate Lyase; HMG-CR-3 - Reductase 3-hydroxy-3-methyl-glutaryl-coenzyme A Reductase; NPC1L1 - Niemann-Pick C1-like 1 protein; PPARα - Peroxisome Proliferator-activated
Receptor-α; VLDL - Very Low Density Lipoprotein; HeFH- Heterozygous Familial Hypercholesterolemia; HoFH - Homozygous Familial Hypercholesterolemia.
Image 2. Schematic presentation of the mechanism of action of lipid-lowering drugs

Legend: ACL - Adenosine triphosphate-Citrate Lyase; HMG-CR-3 - Reductase 3-hydroxy-3-methyl-glutaryl-coenzyme A Reductase; Apo - Apolipoprotein; MTP - Mitochondrial Trifunctional
Protein; TG - Triglycerides; VLDL - Very Low Density Lipoprotein; LDL - Low Density Lipoprotein; LDL-R - Low Density Lipoprotein Receptor; IDL - Intermediate Density Lipoprotein; Lp (a)
- lipoprotein (a); LPL - Lipoprotein Lipase; NPC1L1 - Niemann-Pick C1-like 1 protein; LRP1 - Low-density Receptor-related Protein 1; PCSK9 mRNA - PCSK9 informational RNK; PCSK9 mab
- PCSK9 monoclonal antibodies.

The effectiveness and safety of bempedoic acid in pa- with familial hypercholesterolemia, combined with hypertri-
tients who do not tolerate statins have been investigated in glyceridemia, and in patients with atherosclerotic cardiovas-
several studies, with the most significant being the CLEAR cular disease 21-23 .
study. After conducting clinical trials, bempedoic acid is in-
dicated for use in lowering LDL cholesterol levels in patients

REVIEW PAPER Galenika Medical Journal, 2024; 3(9):26-34. 29