This is fantastic and very timely. Note the absence of niacin and fibrates, which I am still seeing prescribed. It is good to have a gathering of data on which non-statin therapies are worth using and what backs them up. Looking forward to the newest drugs showing real MACE reductions, hopefully.

Key Points
• Source: Journal of the American College of Cardiology
• Conclusion: “This ECDP [Expert Consensus Decision Pathway] addresses current gaps in care for LDL-C lowering to reduce ASCVD risk and provides recommendations that build on the evidence base established by the 2013 ACC/AHA and 2018 AHA/ACC/multisociety cholesterol guidelines. The algorithms endorse the 4 evidence-based patient management groups identified in the guidelines and assume that the patient is currently taking or has attempted to take a statin, given that this is the most effective initial therapy.”
• Various non-statins have been effective at lowering LDL-C ever since the publication of the 2018 AHA/ACC/multisociety cholesterol guidelines
• Large controlled cardiovascular outcomes trials are under way for bempedoic acid and inclisiran.
• Currently, much remains to be determined regarding guidance with non-statin treatments.
• “If additional LDL-C lowering is desired after the addition of ezetimibe and/or a PCSK9 mAb (<50% reduction in LDL-C or LDL-C ≥70 mg/dL or non–HDL-C ≥100 mg/dL), it is reasonable to engage in a clinician-patient discussion with consideration of the net benefit of bempedoic acid,” the authors wrote. “This medication may be especially useful in patients with statin-associated myalgias.”
• Bempedoic acid results in an average additional reduction of LDL-C by 17%. It is effective in patients who are statin intolerant or intolerant of other non-statins, as well as in patients who desire to not use injectable medications. Caution should be employed when using bempedoic acid in those with a history of gout or tendon rupture.