Non-statin lipid-lowering agents: ezetimibe, PCSK9 inhibitors, fibrates and omega-3
Mechanisms and numbers for ezetimibe (NPC1L1), PCSK9 antibodies and inclisiran, bempedoic acid, fibrates, omega-3 fatty acids and bile acid sequestrants, with worked LDL calculations, outcome trials and Australian PBS status.
Tier 2Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Non-statin drugs either add LDL lowering (ezetimibe, PCSK9 inhibitors, inclisiran, bempedoic acid, bile acid sequestrants) or lower triglycerides (fibrates, omega-3 fatty acids).
- Event reduction follows LDL lowering whatever the mechanism, roughly 22% per 1 mmol/L. Triglyceride drugs have weaker and inconsistent outcome data.
- Paper 1 tests molecular targets (NPC1L1, PCSK9, ATP citrate lyase, PPAR-alpha), worked LDL calculations, trial results and drug-specific adverse effects.
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Sources
- Therapeutic Guidelines: CardiovascularAU/NZTherapeutic Guidelines Ltd, current eTG edition (version not verified)
- Mach F, Koskinas KC, Roeters van Lennep JE et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J 2025;46(42):4359-4378European Society of Cardiology, 2025
- Inclisiran: PBS listing from 1 April 2024 and PBAC public summary document (March 2023)AU/NZPharmaceutical Benefits Scheme, 2023-2024
- Bempedoic acid and bempedoic acid with ezetimibe: PBS medicine status (PBAC July 2026, not recommended)AU/NZPharmaceutical Benefits Scheme, current at 1 November 2026
- Evolocumab public summary document, July 2022 (extension to LDL 1.8 to 2.6 mmol/L)AU/NZPharmaceutical Benefits Scheme, 2022
- Cannon CP, Blazing MA, Giugliano RP et al. Ezetimibe added to statin therapy after acute coronary syndromes (IMPROVE-IT). N Engl J Med 2015;372:2387-97N Engl J Med, 2015
- Sabatine MS, Giugliano RP, Keech AC et al. Evolocumab and clinical outcomes in patients with cardiovascular disease (FOURIER). N Engl J Med 2017;376:1713-22N Engl J Med, 2017
- Nissen SE, Lincoff AM, Brennan D et al. Bempedoic acid and cardiovascular outcomes in statin-intolerant patients (CLEAR Outcomes). N Engl J Med 2023;388:1353-64N Engl J Med, 2023
- Bhatt DL, Steg PG, Miller M et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia (REDUCE-IT). N Engl J Med 2019;380:11-22N Engl J Med, 2019
- Last updated
- 14 November 2026
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