What is the generic name of the ACL (ATP citrate lyase) inhibitor used to treat hypercholesterolemia?

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Multiple Choice

What is the generic name of the ACL (ATP citrate lyase) inhibitor used to treat hypercholesterolemia?

The key idea is that ATP citrate lyase is an early enzyme in hepatic cholesterol synthesis, so blocking it reduces the liver’s production of cholesterol and leads to more LDL receptors on liver cells, pulling LDL cholesterol out of the blood. Bempedoic acid fits this mechanism perfectly. It is a prodrug that is activated in the liver and inhibits ACL, lowering hepatic cholesterol production and thereby reducing LDL-C. It’s used as add-on therapy to statins or for patients who can’t tolerate statins, with potential fewer muscle-related side effects because activation happens mainly in the liver. The other options target different steps: fenofibrate mainly lowers triglycerides and raises HDL via PPAR-alpha; rosuvastatin inhibits HMG-CoA reductase (a downstream step in cholesterol synthesis); ezetimibe blocks intestinal cholesterol absorption. None of these inhibit ACL.

The key idea is that ATP citrate lyase is an early enzyme in hepatic cholesterol synthesis, so blocking it reduces the liver’s production of cholesterol and leads to more LDL receptors on liver cells, pulling LDL cholesterol out of the blood.

Bempedoic acid fits this mechanism perfectly. It is a prodrug that is activated in the liver and inhibits ACL, lowering hepatic cholesterol production and thereby reducing LDL-C. It’s used as add-on therapy to statins or for patients who can’t tolerate statins, with potential fewer muscle-related side effects because activation happens mainly in the liver.

The other options target different steps: fenofibrate mainly lowers triglycerides and raises HDL via PPAR-alpha; rosuvastatin inhibits HMG-CoA reductase (a downstream step in cholesterol synthesis); ezetimibe blocks intestinal cholesterol absorption. None of these inhibit ACL.

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