How Do ACL Inhibitors Work?

Lipid-lowering agents also known as cholesterol-lowering, hypolipidemic, or antihyperlipidemic agents are a group of drugs used to reduce high levels of lipids (fats) and lipoproteins (fats with protein) in the blood. These drugs are used to treat cardiovascular abnormalities such as atherosclerosis (build-up of fats and other substances in the wall of arteries, causing obstruction of blood flow) and decrease the risk of potential heart attacks. Lipid-lowering agents include:

• 2-Azetidiones
• Adenosine triphosphate-citrate lyase (ACL) inhibitors
• Apolipoprotein B antisense oligonucleotides
• Microsomal triglyceride transfer protein inhibitors
• Statins (β-hydroxy β-methylglutaryl-CoA [HMG-CoA] reductase inhibitors)
• Fibrates
• Bile acid sequestrants
• Omega 3 acids
• Vitamin B3

ACL inhibitors are a new class of drugs that work by inhibiting the enzyme ACL which then inhibits HMG-CoA enzyme. HMG-CoA enzyme is essential for the formation of cholesterol through the cholesterol biosynthesis pathway in the liver.

As the production of cholesterol decreases in the liver due to ACL inhibition, the liver cells increase the uptake of low-density lipoprotein (LDL, bad cholesterol) present in the blood to make more cholesterol, and this reduces the levels of LDL cholesterol.

These drugs may be taken alone or in a combination with other lipid-lowering agents. A healthy diet and exercise are recommended while taking these drugs to maintain good levels of cholesterol.

ACL inhibitors are taken orally and are used to treat conditions such as:

• Atherosclerotic cardiovascular disease
• Heterozygous familial hypercholesterolemia (a life-threatening genetic condition that increases LDL cholesterol levels in the body)

Common side effects of ACL inhibitors include:

• Abdominal pain
• Joint pain
• Severe dizziness
• Trouble breathing
• Itching and swelling of face, tongue, or throat
• Flu-like symptoms
• Muscle spasms or pain
• Backache
• Serious side effects of ACL inhibitors may include:
• Hyperuricemia (high amount of uric acid in the blood)
• Atrial fibrillation (irregular and fast beats seen in the upper chambers of the heart)
• Increase in liver enzymes
• Difficulty in passing urine
• Hypersensitivity reaction
• Tendon damage
• Leukocytopenia (decrease in white blood cells)

The information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of ACL inhibitors drugs include:

• Bempedoic acid (Nexletol)
• Bempedoic acid/ezetimibe (Nexlizet)