Hypercholesterolemia is one of the major risk factors for the development of
cardiovascular disease.
Atherosclerosis resulting from
hypercholesterolemia causes many serious
cardiovascular diseases.
Statins are generally accepted as a treatment of choice for lowering
low-density lipoprotein (
LDL) cholesterol, which reduces
coronary heart disease morbidity and mortality. Since
statin use can be associated with muscle problems and other adverse symptoms, non-adherence and discontinuation of
statin therapy often leads to inadequate control of plasma
cholesterol levels and increased cardiovascular risk. Moreover, there is compelling evidence on the presence of still considerable residual cardiovascular risk in
statin-treated patients.
Ezetimibe improves
cholesterol-lowering efficacy and provides mild additional cardiovascular protection when combined with
statin treatment. Despite a favorable safety profile compared to
statins,
ezetimibe-induced
cholesterol-lowering is modest when used alone. Hence, there is a critical need to identity additional effective
hypolipidemic agents that can be used either in combination with
statins, or alone, if
statins are not tolerated. Thus,
hypolipidemic agents such as
proprotein convertase subtilisin/kexin type 9 (
PCSK9) inhibitors,
apolipoprotein B-100 antisense oligonucleotides,
cholesteryl ester transfer protein (CETP) inhibitors, and
microsomal triglyceride transfer protein (
MTTP) inhibitors, as well as yeast
polysaccharides (
beta-glucans and
mannans) and compounds derived from natural sources (nutraceuticals) such as glucomannans,
plant sterols,
berberine, and
red yeast rice are being used. In this review, we will discuss
hypercholesterolemia, its impact on the development of
cardiovascular disease (CVD), and the use of yeast
polysaccharides, various nutraceuticals, and several therapeutic agents not derived from 'natural' sources, to treat
hypercholesterolemia.