Table 1 Advantages and disadvantages of hypolipidemic drugs
From: Low-density lipoprotein cholesterol lowering treatment: the current approach
Molecules | Advantages | Disadvantages |
|---|---|---|
Statins | - Extensively studied - Reduction of LDLc, but also pleiotropic effects - Beneficial effect on cardiovascular morbidity and mortality | - Adverse effects such as myopathy, usually mild adverse effects on liver function Several important drug interactions |
Cholesterol absorbtion inhibitors | - Added to statin therapy, reduces LDLc levels - Useful when statin therapy not possible | - Same adverse effects as statins, while not worsening them in combination with statins |
Bile acid sequestrants | - Reduction of LDLc, when added to statins - May reduce glucose levels in hyperglycaemic patients | - Gastrointestinal adverse effects - May increase TG levels - Drug interactions |
Nicotinic acid | - Raise of HDLc and ApoA1 | - Benefits not entirely proven in studies |
Fibrates | - Substantial decrease of TG, moderate decrease of LDLc and increase of HDLc | - Gastrointestinal adverse effects - Raise of creatinine and homocysteine levels |
PCSK9 inhibitors | - Powerful effect on LDLc levels, in line with cardiovascular risk reduction | - Administration by subcutaneous injections - High costs - Limited indications |
Mipomersen | - Reduction of LDLc in homozygous familial hypecholesterolemia | - Administration by subcutaneous injections - Liver toxicity - Not approved in Europe |
Lomitapide | - Reduction of LDLc in homozygous familial hypecholesterolemia - Also approved in Europe | - Hepatic adverse effects |