Displaying publications 1 - 20 of 23 in total

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  1. Ng WK
    Asia Pac J Clin Nutr, 2002;11 Suppl 7:S473-6.
    PMID: 12492637
    One key ingredient used in the formulation of aquafeed is fish oil, which is produced from small marine pelagic fish and represents a finite fishery resource. At the present time, global fish oil production has reached a plateau and is not expected to increase beyond current levels. Recent estimates suggest that fish oils may be unable to meet demands from the rapidly growing aquaculture industry by as early as 2005. Therefore, there is currently great interest within the aquafeed industry in evaluating alternatives to fish oils. The ever-expanding oil palm cultivation in Malaysia and other tropical countries offers the possibility of an increased and constant availability of palm oil products for aquafeed formulation. Research into the use of palm oil in aquafeed begun around the mid-1990s and this review examines some of the findings from these studies. The use of palm oil in fish diets has generally shown encouraging results. Improved growth, feed efficiency, protein utilisation, reproductive performance and higher concentrations of alpha-tocopherol in fish fillets have been reported. Recent evidence for the ability of palm oil to substitute for fish oil in catfish diets is reviewed. The potential of palm oil use in aquafeed and future experimental directions are suggested. The aquaculture feed industry offers a great avenue to increase and diversify the use of palm oil-based products.
  2. Teoh CY, Ng WK
    J Agric Food Chem, 2013 Jun 26;61(25):6056-68.
    PMID: 23718861 DOI: 10.1021/jf400904j
    The present study aimed to investigate the potential role of dietary petroselinic acid (PSA) in enhancing the n-3 long-chain polyunsaturated fatty acid (LC-PUFA) content in fish tissues. Three isolipidic casein-based diets were formulated to comprise graded levels of PSA (0, 10, or 20% of total fatty acid) with the incremented inclusion of coriander seed oil. Fish growth and nutrient digestibility were not significantly (P > 0.05) influenced by dietary PSA level. In general, dietary PSA affected the fatty acid composition of tilapia tissues and whole-body, which reflected dietary fatty acid ratios. Dietary PSA significantly (P < 0.05) increased β-oxidation, particularly on α-linolenic acid (18:3n-3) and linoleic acid (18:2n-6). This study provided evidence that PSA, a pseudoproduct mimicking the structure of 18:3n-6, did reduce Δ-6 desaturation on 18:2n-6 but, contrary to popular speculation, did not stimulate more Δ-6 desaturase activity on 18:3n-3. The overall Δ-6 desaturase enzyme activity may be suppressed at high dietary levels of PSA. Nevertheless, the n-3 and n-6 LC-PUFA biosynthesis was not significantly inhibited by dietary PSA, indicating that the bioconversion efficiency is not modulated only by Δ-6 desaturase. The deposition of n-3 LC-PUFA in liver and fillet lipids was higher in fish fed PSA-supplemented diets.
  3. Rohani-Ghadikolaei K, Abdulalian E, Ng WK
    J Food Sci Technol, 2012 Dec;49(6):774-80.
    PMID: 24293698 DOI: 10.1007/s13197-010-0220-0
    The proximate, fatty acid and mineral composition were determined for green (Ulva lactuca and Enteromorpha intestinalis), brown (Sargassum ilicifolium and Colpomenia sinuosa) and red (Hypnea valentiae and Gracilaria corticata) seaweeds collected from the Persian Gulf of Iran. Results showed that the seaweeds were high in carbohydrate (31.8-59.1%, dry weight) and ash (12.4-29.9%) but low in lipid content (1.5-3.6%). The protein content of red or green seaweeds was significantly higher (p 
  4. Lee KS, Yuen KH, Ng WK
    Fish Physiol Biochem, 2013 Dec;39(6):1457-71.
    PMID: 23604920 DOI: 10.1007/s10695-013-9799-1
    Vitamin E, a potent antioxidant consisting of four isomers each (α, β, γ, δ) of tocopherol (T) and tocotrienol (T3), is found naturally in plant oils at different concentrations. In this study, four semi-purified isonitrogenous and isolipidic (10 %) diets containing canola oil, cold-pressed soybean oil, wheat germ oil, or palm fatty acid distillates (PFAD) as the sole vitamin E source were fed to triplicate groups of red hybrid tilapia (Oreochromis sp.) fingerlings (14.82 ± 0.05 g) for 45 days. Vitamin E concentrations and composition were measured in the muscle, liver, skin, and adipose tissue. Deposition of α-T (53.4-93.1 % of total vitamin E) predominated over deposition of other isomers, except in the liver of fish fed the SBO diet, where α-T and γ-T deposition was in the ratio 40:60. T3 deposition (2.6-29.4 %) was only detected in tissues of fish fed the PFAD diet; adipose tissue was the major storage depot. Fish fed the SBO diet contained significantly more (P 
  5. Ng WK, Yazan LS, Ismail M
    Toxicol In Vitro, 2011 Oct;25(7):1392-8.
    PMID: 21609759 DOI: 10.1016/j.tiv.2011.04.030
    Thymoquinone (TQ), the active constituent of Nigella sativa or black cumin exhibited cytotoxic effects in several cancer cell lines. In this study, the cytotoxicity of TQ in human cervical squamous carcinoma cells (SiHa) was investigated. TQ was cytotoxic towards SiHa cells with IC50 values of 10.67 ± 0.12 and 9.33 ± 0.19 μg/mL as determined by MTT assay and trypan blue dye exclusion test, respectively, after 72 h of incubation. TQ was more cytotoxic towards SiHa cells compared to cisplatin. Interestingly, TQ was less cytotoxic towards the normal cells (3T3-L1 and Vero). Cell cycle analysis performed by flowcytometer showed a significant increase in the accumulation of TQ-treated cells at sub-G1 phase, indicating induction of apoptosis by the compound. Apoptosis induction by TQ was further confirmed by Annexin V/PI and AO/PI staining. Significant elevation of p53 and down-regulation of the anti-apoptotic Bcl-2 protein was found in the treated cells, without any changes in the expression of the pro-apoptotic Bax protein. In conclusion, thymoquinone from N. sativa was more potent than cisplatin in elimination of SiHa cells via apoptosis with down-regulation of Bcl-2 protein.
  6. Ng WK, Samad SA, Tan CT
    Med J Malaysia, 1996 Mar;51(1):151-3.
    PMID: 10967999
    Spinal vascular malformation is an uncommon but potentially treatable cause of myelopathy. We describe two cases of angiographically proven spinal vascular malformation in Malaysia. The first case is a 47-year-old man who had a progressive myelopathy and the second a 60-year-old man with intermittent attacks of transient paraparesis leading to paraplegia. As the clinical presentation of spinal vascular malformation is variable, it should be considered as a cause of patients with myelopathy.
  7. Lee MK, Ng WK, Jeyakumar D
    Med J Malaysia, 1994 Sep;49(3):297-300.
    PMID: 7845285
    Huntington disease has not previously been recorded in Malaysia. We report the first case in a local patient with a positive family history. The implications of diagnosing this disease will be discussed.
  8. Ng WK, Lim TS, Lai NS
    Biotechnol Appl Biochem, 2018 Jul;65(4):547-553.
    PMID: 29280199 DOI: 10.1002/bab.1636
    A critical challenge in producing an antibody-based assay with the highest reproducibility and sensitivity is the strategy to immobilize antibodies to solid phase. To date, numerous methods of antibody immobilization were reported but each was subjected to its advantages and limitations. The current study proposes a new potential antibody binding protein, the human neonatal fragment crystallizable (Fc) receptor. This protein has shown its high affinity to the Fc of antibody either in vivo or in vitro. Human neonatal Fc receptor is a heterodimer constructed by p51 α-heavy chain and β2-microglobulin light chain; however, the binding sites toward the antibody are located in the p51 α-heavy chain. Hence, vector cloning and recombinant protein expression were carried out to express the p51 α-heavy chain of the human neonatal Fc receptor (hFcRn-α). The recombinant protein expressed, hFcRn-α, was adopted to pin rabbit IgG against hepatitis B virus surface antigen to a solid phase. A sandwich enzyme-linked immunosorbent assay was further developed to evaluate the efficiency of hFcRn-α-directed immobilization in antigen detection. The result was compared with the conventional physical adsorption method. The findings demonstrated that human neonatal Fc receptor was efficient in pinning antibodies and generating higher signals compared with the physical adsorption of antibody.
  9. Ng WK, Lim TS, Lai NS
    Protein Expr Purif, 2016 11;127:73-80.
    PMID: 27412717 DOI: 10.1016/j.pep.2016.07.004
    Neonatal Fc-receptor (FcRn) with its affinity to immunoglobulin G (IgG) has been the subject of many pharmacokinetic studies in the past century. This protein is well known for its unique feature in maintaining the circulating IgG from degradation in blood plasma. FcRn is formed by non-covalent association between the α-chain with the β-2-microglobulin (β2m). Many studies have been conducted to produce FcRn in the laboratory, mainly using mammalian tissue culture as host for recombinant protein expression. In this study, we demonstrate a novel strategy to express the α-chain of FcRn using Escherichia coli as the expression host. The expression vector that carries the cDNA of the α-chain was transformed into expression host, Rosetta-gami 2 strain for inducible expression. The bacterial culture was grown in a modified growth medium which constitutes of terrific broth, sodium chloride (NaCl), glucose and betaine. A brief heat shock at 45 °C was carried out after induction, before the temperature for expression was reduced to 22 °C and grown for 16 h. The soluble form of the α-chain of FcRn expressed was tested in the ELISA and dot blot immunoassay to confirm its native functionality. The results implied that the α-chain of FcRn expressed using this method is functional and retains its pH-dependent affinity to IgG. Our study significantly suggests that the activity of human FcRn remain active and functional in the absence of β2m.
  10. Ismail NM, Jaarin K, Ahmad A, Marzuki A, Ng WK, Gapor MT
    Asia Pac J Clin Nutr, 1999 Dec;8(4):258-62.
    PMID: 24394225
    The main focus of the study was to examine the effect of palm vitamin E (a tocotrienol-enriched fraction of palm oil) on the healing of ethanol-induced gastric mucosal lesions. The study was divided into three sections.Study 1 determined the gastric content of vitamin E after dietary supplementation with palm vitamin E for 3 weeks. Seven rats were fed a normal diet and another 7 were fed a palm vitamin E-enriched diet (150 mg/kg food). The gastric content of vitamin E levels were higher in rats fed with a palm vitamin E-enriched diet (p<0.01). Study 2 determined the time-dependent effects of palm vitamin E on gastric lesions and gastric acidity postethanol administration. Two groups of rats were fed either a normal rat diet or a palm vitamin E-enriched diet (150 mg/kg food). After 3 weeks, the control and a treated group received a single intragastric dose of 100% ethanol. Assessment of gastric lesions after 1 week showed a lower gastric lesion index in the palm vitamin E group compared with the controls (p<0.05) but there was no difference in the gastric acid content after 1 week between the two groups. Study 3 determined the effects of palm vitamin E on the gastric tissue content of malondialdehyde (MDA), PGE2 and gastric acidity without ethanol administration. The MDA content was lower in the palm vitamin E-treated group (p<0.05). However, the gastric acid and PGE2 content in both groups did not differ. The findings suggest that feeding with a palm vitamin E-enriched diet (150 mg/kg food) for 3 weeks resulted in a significant concentration of vitamin E in the gastric tissue. It was concluded that palm vitamin E may promote the healing of ethanol-induced gastric lesions through minimizing the lipid preoccupation process in the gastric mucous.
  11. Ng WK, Tan CT, George J, Lee MK, Loh TG
    Med J Malaysia, 1995 Jun;50(2):186-8.
    PMID: 7565194
    Moyamoya disease is a rare cause of young strokes. The definitive diagnosis of moyamayo disease is made by cerebral angiography. We report two cases of moyamoya disease in Malaysia.
  12. Ng WK, Campbell PJ, Dick JR, Bell JG
    Lipids, 2003 Oct;38(10):1031-8.
    PMID: 14669967
    An experiment was conducted to evaluate the interactive effects of dietary crude palm oil (CPO) concentration and water temperature on lipid and FA digestibility in rainbow trout. Four isolipidic diets with 0, 5, 10, or 20% (w/w) CPO, at the expense of fish oil, were formulated and fed to groups of trout maintained at water temperatures of 7, 10, or 15 degrees C. The apparent digestibility (AD) of the FA, measured using yttrium oxide as an inert marker, decreased with increasing chain length and increased with increasing unsaturation within each temperature regimen irrespective of CPO level fed to the fish. PUFA of the n-3 series were preferentially absorbed compared to n-6 PUFA in all diet and temperature treatments. Except for a few minor FA, a significant (P < 0.05) interaction between diet and temperature effects on FA digestibility was found. Increasing dietary levels of CPO lead to significant reductions in the AD of saturates and, to a lesser extent, also of the other FA. Lowering water temperature reduced total saturated FA digestibility in trout regardless of CPO level. Based on the lipid class composition of trout feces, this reduction in AD of saturates was due in part to the increasing resistance of dietary TAG to digestion. Increasing CPO level and decreasing water temperature significantly increased TAG content in trout fecal lipids, with saturates constituting more than 60% of the FA composition. Total monoene and PUFA digestibilities were not significantly affected by water temperature in fish fed up to 10% CPO in their diet. The potential impact of reduced lipid and FA digestibility in cold-water fish fed diets supplemented with high levels of CPO on fish growth performance requires further research.
  13. Ng WK, Saiful Yazan L, Yap LH, Wan Nor Hafiza WA, How CW, Abdullah R
    Biomed Res Int, 2015;2015:263131.
    PMID: 25632388 DOI: 10.1155/2015/263131
    Thymoquinone (TQ) has been shown to exhibit antitumor properties. Thymoquinone-loaded nanostructured lipid carrier (TQ-NLC) was developed to improve the bioavailability and cytotoxicity of TQ. This study was conducted to determine the cytotoxic effects of TQ-NLC on breast cancer (MDA-MB-231 and MCF-7) and cervical cancer cell lines (HeLa and SiHa). TQ-NLC was prepared by applying the hot high pressure homogenization technique. The mean particle size of TQ-NLC was 35.66 ± 0.1235 nm with a narrow polydispersity index (PDI) lower than 0.25. The zeta potential of TQ-NLC was greater than -30 mV. Polysorbate 80 helps to increase the stability of TQ-NLC. Differential scanning calorimetry showed that TQ-NLC has a melting point of 56.73°C, which is lower than that of the bulk material. The encapsulation efficiency of TQ in TQ-NLC was 97.63 ± 0.1798% as determined by HPLC analysis. TQ-NLC exhibited antiproliferative activity towards all the cell lines in a dose-dependent manner which was most cytotoxic towards MDA-MB-231 cells. Cell shrinkage was noted following treatment of MDA-MB-231 cells with TQ-NLC with an increase of apoptotic cell population (P < 0.05). TQ-NLC also induced cell cycle arrest. TQ-NLC was most cytotoxic towards MDA-MB-231 cells. It induced apoptosis and cell cycle arrest in the cells.
  14. Wang L, Xu B, Sagada G, Ng WK, Chen K, Zhang J, et al.
    Br J Nutr, 2021 Mar 14;125(5):481-493.
    PMID: 32718379 DOI: 10.1017/S0007114520003025
    The present study investigated the influence of berberine (BBR) supplementation in normal and high-lipid (HL) diets on lipid metabolism and accumulation in black sea bream (Acanthopagrus schlegelii). BBR was supplemented at 50 mg/kg to control (Con, 11·1 % crude lipid) and high-lipid (HL, 20·2 % crude lipid) diets and named as ConB and HLB, respectively. After the 8-week feeding trial, fish body length and specific growth rate were significantly reduced by HL diets (P < 0·05). Muscle and whole-body crude lipid contents were significantly influenced by both BBR supplementation and dietary lipid level. Fish fed the HLB diet had significantly lower serum TAG, LDL-cholesterol contents and alanine aminotransferase activity compared with the HL group. The HL group presented vast lipid accumulation in the liver, and hypertrophied hepatocytes along with large lipid droplets, and translocation of nuclear to the cell periphery. These abnormalities in black sea bream were alleviated in the HLB group. BBR supplementation in the HL diet significantly down-regulated the hepatic expression levels of acetyl-CoA carboxylase α, sterol regulatory element-binding protein-1, 6-phosphogluconate dehydrogenase, glucose 6-phosphate dehydrogenase and pparγ, whereas the lipoprotein lipase, hormone-sensitive lipase and carnitine palmitoyltransferase 1a expression levels were significantly up-regulated. However, the expression levels of these genes showed opposite trends in muscle (except for pparγ). In conclusion, dietary BBR supplementation in the HL diet reduced hepatic lipid accumulation by down-regulating lipogenesis gene expression and up-regulating lipolysis gene expression, and it increased muscle lipid contents with opposite trends of the mechanism observed in the liver.
  15. Wan Nor Amilah WA, Noor Izani NJ, Ng WK, Ashraful Haq J
    Trop Biomed, 2012 Dec;29(4):588-97.
    PMID: 23202604
    Clinical utilization of carbapenems remains under threat with the emergence of acquired carbapenemase-producing bacteria, particularly metallo-β-lactamases (MBL). Rapid detection of MBL-producing Gram-negative bacilli is essential to prevent their widespread dissemination. However, no standardized detection method is available for routine laboratory use. The purpose of the study was to evaluate a chelating-agent based double disk synergic test and disk potentiation test for MBL-producing strain detection and to determine the isolation rate of MBL-producing Pseudomonas aeruginosa and Acinetobacter from clinical samples in our tertiary teaching hospital. A total of 22 and 66 imipenem-resistant P. aeruginosa and Acinetobacter isolates respectively were tested with ceftazidime (CAZ) disk by modified double disk synergic test and disk potentiation test using ethylenediaminetetraacetic acid (EDTA) and 2-mercaptopropionic acid (as chelating agents) to detect MBL production. The tests were compared with EDTA-phenanthroline-imipenem (EPI) microdilution MIC test as gold standard. MBL positive strains were detected in 17 (77.3%) P. aeruginosa and 2 (3.5%) Acinetobacter isolates. The disk potentiation test with 2-mercaptopropionic acid (2-MPA) dilution of 1:12 provided the most acceptable sensitivities and specificities (88.2% sensitivity and 100% specificity in P. aeruginosa; 100% sensitivity and specificity in Acinetobacter) compared to other screening methods used in this study. This study provided useful information on the local prevalence of MBL-producing P. aeruginosa and Acinetobacter in our hospital. Disc potentiation test with CAZ/2-MPA disc appears to be reliable and convenient MBL detection method in the routine clinical laboratory.
  16. Ong YS, Saiful Yazan L, Ng WK, Noordin MM, Sapuan S, Foo JB, et al.
    Int J Nanomedicine, 2016 11 09;11:5905-5915.
    PMID: 27877037
    BACKGROUND: Thymoquinone (TQ), the predominant active lipophilic component in Nigella sativa seed oil, has a variety of pharmacological properties such as anticancer activities. However, translation of TQ to clinical phase is still not possible due to its hydrophobic properties. This problem can be solved by encapsulating it in nanoformulations to enhance its pharmacological properties. In our previous study, TQ has been successfully encapsulated in a nanostructured lipid carrier (hereinafter referred to as TQNLC) with excellent physiochemical properties such as high encapsulation efficiency, high drug-loading capacity, particle diameter less than 100 nm, and stability up to 2 years. In vitro studies also proved that TQNLC exhibited antiproliferative activity toward breast and cervical cancer cell lines. However, no toxicity profile related to this formulation has been reported. In this study, we determine and compare the in vivo toxicity of both TQNLC and TQ.

    MATERIALS AND METHODS: The in vivo toxicity (acute and subacute toxicity) study was carried out by oral administration of TQNLC and TQ to BALB/c mice. Animal survival, body weight, organ weight-to-body weight ratio, hematological profile, biochemistry profile, and histopathological changes were analyzed.

    RESULTS: In acute toxicity, TQ that is loaded in nanostructured lipid carrier (NLC) was found to be less toxic than pure TQ. It can be concluded that encapsulation of TQ in lipid carrier minimizes the toxicity of the compound. In the subacute toxicity study, oral administration of 100 mg/kg of TQNLC and TQ did not cause mortality to either male or female but resulted in toxicity to the liver. It is postulated that long-term consumption of TQNLC and TQ may cause toxicity to the liver but not to the extent of altering the functions of the organ. For both treatments, the no observed adverse effect level (NOAEL) was found to be 10 mg/kg/d for mice in both sexes.

    CONCLUSION: For long-term oral consumption, TQ and TQNLC at a dose of 10 mg/kg is safe in mice and does not exert any toxic effect. The results provide safety information of TQNLC, which would further help researchers in clinical use.

  17. Ng WK, Philip AZ, Lim TT, Wong M, Goh EL, Tengku Ismail TS, et al.
    Med J Malaysia, 2023 May;78(3):350-356.
    PMID: 37271845
    INTRODUCTION: In managing hypertension, monotherapy and sometimes a combination of more than one agent are used to achieve blood pressure (BP) control. The objective of this prospective, observational, multi-centre study was to assess the level of BP control in patients receiving one or more anti-hypertensive drugs in private medical centres in Malaysia according to the treatment regimens (monotherapy, free drug combinations and single pill combinations).

    MATERIALS AND METHODS: Data were collected through medical records and interview sessions with patients on current pharmacotherapy for hypertension management at baseline and 2-3 months later. Results are expressed as mean ± SD for continuous data and as frequencies and percentages for categorical data.

    RESULTS: Among 182 recruited patients, 89 (49%) achieved BP control by the end of the study. Majority (62/89) patients were on single-pill (monotherapy or SPC) antihypertensives. Majority (63/89) required more than two antihypertensives to achieve BP control.

    CONCLUSION: Both SPC and free drug combination antihypertensives reduced BPs, but physicians preferred SPC to improve BP control and increase treatment compliance.

  18. Pung HS, Tye GJ, Leow CH, Ng WK, Lai NS
    Mol Biol Rep, 2023 May;50(5):4653-4664.
    PMID: 37014570 DOI: 10.1007/s11033-023-08380-x
    Cancer is one of the leading causes of mortality worldwide; nearly 10 million people died from it in 2020. The high mortality rate results from the lack of effective screening approaches where early detection cannot be achieved, reducing the chance of early intervention to prevent cancer development. Non-invasive and deep-tissue imaging is useful in cancer diagnosis, contributing to a visual presentation of anatomy and physiology in a rapid and safe manner. Its sensitivity and specificity can be enhanced with the application of targeting ligands with the conjugation of imaging probes. Phage display is a powerful technology to identify antibody- or peptide-based ligands with effective binding specificity against their target receptor. Tumour-targeting peptides exhibit promising results in molecular imaging, but the application is limited to animals only. Modern nanotechnology facilitates the combination of peptides with various nanoparticles due to their superior characteristics, rendering novel strategies in designing more potent imaging probes for cancer diagnosis and targeting therapy. In the end, a myriad of peptide candidates that aimed for different cancers diagnosis and imaging in various forms of research were reviewed.
  19. Tan HJ, Mahadeva S, Menon J, Ng WK, Zainal Abidin I, Chan FK, et al.
    J Dig Dis, 2013 Jan;14(1):1-10.
    PMID: 23134105 DOI: 10.1111/1751-2980.12000
    The working party statements aim to provide evidence and guidelines to practising doctors on the use of antiplatelet therapy and proton pump inhibitors (PPIs) in patients with cardiovascular risk as well as those at risk of gastrointestinal (GI) bleeding. Balancing the GI and cardiovascular risk and benefits of antiplatelet therapy and PPIs may sometimes pose a significant challenge to doctors. Concomitant use of anti-secretory medications has been shown to reduce the risk of GI bleeding but concerns have been raised on the potential interaction of PPIs and clopidogrel. Many new data have emerged on this topic but some can be confusing and at times controversial. These statements examined the supporting evidence in four main areas: rationale for antiplatelet therapy, risk factors of GI bleeding, PPI-clopidogrel interactions and timing for recommencing antiplatelet therapy after GI bleeding, and made appropriate recommendations.
  20. Jeyamalar R, Wan Azman WA, Nawawi H, Choo GH, Ng WK, Rosli MA, et al.
    Med J Malaysia, 2018 06;73(3):154-162.
    PMID: 29962499 MyJurnal
    Cardiovascular disease (CVD) has been the main cause of mortality and an important cause of morbidity in Malaysia for several years. To reduce global cardiovascular (CV) risk in the population, primary preventive strategies need to be implemented. Hypercholesterolaemia is one of the major risk factors for CVD. This paper is an expert review on the management of hypercholesterolemia focusing on high and very high risk individuals. In low and Intermediate risk individuals, therapeutic lifestyle changes (TLC) and a healthy lifestyle alone may suffice. In high and very high risk individuals, drug therapy in conjunction with TLC are necessary to achieve the target LDL-C levels which have been shown to slow down progression and sometimes even result in regression of atherosclerotic plaques. Statins are first-line drugs because they have been shown in numerous randomized controlled trials to be effective in reducing CV events and to be safe. In some high risk individuals, despite maximally tolerated statin therapy, target Low Density Lipoprotein Cholesterol (LDL-C) levels are not achieved. These include those with familial hypercholesterolaemia and statin intolerance. This paper discusses non-statin therapies, such as ezetimibe and the newer Proprotein convertase subtilisin/kexin type 9 Inhibitors (PCSK9-i).
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