How to treat fatty deposits due to hypercholesterolemia (high cholesterol)?

From the Guidelines

To treat fatty deposits due to cholesterol, the primary approach is to lower your blood cholesterol levels through a combination of medication and lifestyle changes, with statins being the first-line medication treatment, as recommended by the 2013 ACCF/AHA guidelines 1. The goal of treatment is to reduce the levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol, which is the primary cause of fatty deposits.

• Statins, such as atorvastatin (10-80mg daily), rosuvastatin (5-40mg daily), or simvastatin (10-40mg daily), are the most effective medications for lowering LDL cholesterol levels, and are recommended as the first-line treatment by the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines 1.
• In addition to medication, lifestyle changes such as adopting a heart-healthy diet low in saturated fats and trans fats, increasing physical activity to at least 150 minutes of moderate exercise weekly, maintaining a healthy weight, and avoiding smoking are also essential for reducing cholesterol levels and preventing the formation of fatty deposits.
• The American Heart Association guidelines also recommend therapeutic lifestyle changes, including diet, weight management, and increased physical activity, as well as consideration of drug therapy if LDL-C is above goal range 1.
• Regular monitoring of cholesterol levels through blood tests is essential to ensure treatment effectiveness and to adjust the treatment plan as needed.
• It is also important to note that the treatment of fatty deposits due to cholesterol should be individualized and tailored to the specific needs and risk factors of each patient, and should be done in collaboration with a healthcare provider.

From the FDA Drug Label

INDICATIONS AND USAGE EZETIMIBE Tablets is indicated (1): • In combination with a statin, or alone when additional low density lipoprotein cholesterol (LDL-C) lowering therapy is not possible, as an adjunct to diet to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH) • In combination with a statin as an adjunct to diet to reduce elevated LDL-C in pediatric patients 10 years of age and older with HeFH.

In the atorvastatin calcium placebo-controlled clinical trial database of 16,066 patients (8,755 atorvastatin calcium vs 7,311 placebo; age range 10 to 93 years, 39% female, 91% White, 3% Black or African American, 2% Asian, 4% other) with a median treatment duration of 53 weeks, the most common adverse reactions in patients treated with atorvastatin calcium that led to treatment discontinuation and occurred at a rate greater than placebo were: myalgia (0.7%), diarrhea (0.5%), nausea (0. 4%), alanine aminotransferase increase (0.4%), and hepatic enzyme increase (0. 4%).

Treatment for fatty deposits due to cholesterol can be managed with medications such as ezetimibe and atorvastatin.

• Ezetimibe is indicated for use in combination with a statin or alone to reduce elevated LDL-C in adults with primary hyperlipidemia.
• Atorvastatin is used to reduce LDL-C levels in patients with hyperlipidemia. Both medications are used as an adjunct to diet to reduce cholesterol levels 2, 3.

From the Research

Treatment Options for Fatty Deposits due to Cholesterol

• There are several treatment options available for managing fatty deposits due to cholesterol, including statins, ezetimibe, and PCSK9 inhibitors 4, 5, 6, 7, 8.
• Statins are the primary treatment for lowering low-density lipoprotein (LDL) cholesterol levels and are recommended as a first-line therapy for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) 4, 5, 7, 8.
• However, some patients may not be able to tolerate statins due to adverse effects, and alternative treatment options such as ezetimibe and PCSK9 inhibitors may be considered 6, 7.

Efficacy of Treatment Options

• Ezetimibe, a cholesterol absorption inhibitor, has been shown to lead to additional LDL cholesterol reduction and decreased ASCVD risk when added to statin therapy 4, 8.
• PCSK9 inhibitors, such as alirocumab and evolocumab, have been approved to lower LDL cholesterol levels and have been shown to significantly decrease serum LDL cholesterol levels and ASCVD risks when added to maximally tolerated statin therapy 4, 6, 7.
• Bempedoic acid, a newer treatment option, has also been shown to reduce hepatic cholesterol synthesis and lower LDL-C levels 7.

Comparison of Treatment Options

• A meta-analysis of randomized trials found that PCSK9 inhibitors lowered LDL-C levels significantly more than ezetimibe in patients not on statins 6.
• Another study found that PCSK9 inhibitors, ezetimibe, and bempedoic acid are evidence-based, non-statin therapies that synergistically lower LDL-C and reduce risk of major adverse cardiovascular events (MACE) 7.
• The choice of treatment option depends on individual patient factors, such as tolerance to statins and presence of comorbidities, and should be made in consultation with a healthcare provider 5, 7.