Learning Cardiology

 Bempedoic Acid A novel nonstatin drug that inhibits cholesterol biosynthesis in liver. Prodrug → converted to active form in liver, not in muscles. # Mechanism of action → ATP-citrate lyase inhibitor. • No muscular side effects. • Does not worsen glycemic control • side effects → Hyperuricemia and gout  Slightly increased risk of tendon rupture ⇒ Major clinical trial - CLEAR wisdom and CLEAR Outcomes ⇒ Indications at present: 1. LDL not effectively reduced with statins -As additional therapy 2. Patients not tolerating stating due to side effects -As monotherapy

  SGLT2 Inhibitors First developed for glycemic control for patients with diabetes, have become one of the four pillars of guideline-directed medical therapy for patients with HF  In 2015, the EMPA-REG OUTCOME study evaluated the impact of empagliflozin on major adverse cardiac events in patients with diabetes and unexpectedly showed a 35% relative risk reduction in hospitalization for HF.   How Do SGLT2 Inhibitors Work?  SGLT2 inhibitors block the reabsorption of sodium in the proximal tubules of the kidney.  Significant natriuresis as well as osmotic diuresis due to glucosuria.  Have also been shown to attenuate adverse cardiac remodeling and fibrosis in animal models. Available drugs Empagliflozin: SGLT 2 inhibitor, Dose 10 mg and 25 mg Dapagliflozin: SGLT2 inhibitor, Dose 5 mg and 10 mg Sotagliflozin: SGLT 1 and 2 inhibitor, Dose 200 mg and 400 mg Sotagliflozin is slightly different than dapagliflozin and empagliflozin in that it is a combined SGLT1/2 inhibitor.  SGLT2 inhibition l