Very High-Risk ASCVD and Eligibility for Nonstatin Therapies Based on the 2018 AHA/ACC Cholesterol Guidelines

Sixty-seven percent of these very high risk patients had low-density lipoprotein cholesterol (LDL-C) of ≥70 mg/dl, and 72% had either LDL-C ≥70 mg/dl or non−high-density lipoprotein cholesterol (HDL-C) ≥100 mg/dl, making them potentially eligible for ezetimibe and/or PCSK9i. Because the guidelines r...

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Bibliographic Details
Published in:Journal of the American College of Cardiology 2019-08, Vol.74 (5), p.712-714
Main Authors: Virani, Salim S., Akeroyd, Julia M., Smith, Sidney C., Al-Mallah, Mouaz, Maddox, Thomas M., Morris, Pamela B., Petersen, Laura A., Ballantyne, Christie M., Grundy, Scott M., Stone, Neil J.
Format: Article
Language:English
Subjects:
American Heart Association
Anticholesteremic Agents - therapeutic use
Atherosclerosis - blood
Atherosclerosis - drug therapy
Biomarkers - blood
Cardiology
Cholesterol
Cholesterol - blood
Density
Disease
Guidelines
High density lipoprotein
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Low density lipoprotein
Practice Guidelines as Topic
Risk
Risk Assessment
Risk Factors
Risk groups
Statins
Therapy
Titration
United States
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Summary:Sixty-seven percent of these very high risk patients had low-density lipoprotein cholesterol (LDL-C) of ≥70 mg/dl, and 72% had either LDL-C ≥70 mg/dl or non−high-density lipoprotein cholesterol (HDL-C) ≥100 mg/dl, making them potentially eligible for ezetimibe and/or PCSK9i. Because the guidelines recommend a stepwise approach of maximizing statins plus ezetimibe before considering a PCSK9i, we evaluated what proportion would continue to have LDL-C ≥70 mg/dl or non−HDL-C ≥100 mg/dl after intensifying statin therapy (6% LDL-C and 4% non−HDL-C lowering with each doubling of dose) and adding ezetimibe (18% LDL-C and 16% non−HDL-C reduction on top of statin therapy) (2). Because the total number of patients with ASCVD receiving care per-facility might also vary, we also calculated the proportion of patients with ASCVD per-facility who would qualify as very high risk and be eligible for a PCSK9i after titration to a high-intensity statin plus ezetimibe.
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2019.05.051