Very high-risk patients with ASCVD are defined as having multiple major ASCVD events or one major ASCVD event and multiple other risk factors such as smoking, hypertension, diabetes, or persistent elevated LDL-C to name a few.¹ While unclear exactly how many patients are considered very high-risk, separate studies show a range of 26-58% of ASCVD patients may be classified as very high-risk.^2-3 The most recent ACC/AHA guideline recommends optimizing LDL-C management in very high-risk ASCVD patients with high-intensity statin therapy or maximally tolerated statin therapy.¹ The guidelines further recommend using an LDL-C threshold of 70 mg/dL (1.8 mmol/L) in very high-risk ASCVD patients when considering the addition of nonstatins to statin therapy.¹

• What percentage of your own secondary prevention patients would you classify as being very high-risk?
• Of those very high-risk patients, what percentage would you estimate are at goal utilizing statins alone?
• Do you feel that 70 mg/dL LDL-C is low enough to prevent additional ASCVD events or do you target even lower? Should ACC/AHA LDL-C guidelines be adjusted to provide an LDL-C goal ≤55 mg/dL, similar to ESC⁴?

References:

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24):3168-3209
2. Sajja A, Li HF, Spinelli KJ, et al. A simplified approach to identification of risk status in patients with atherosclerotic cardiovascular disease. American Journal of Preventive Cardiology 2021; (7): 100187
3. Colantonio LD, Shannon ED, Orroth KK, et al. Ischemic Event Rates in Very-High-Risk Adults. Journal of the American College of Cardiology, 2019; 74(20): 2496-2507
4. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2020; 41(1): 111–188

Very high-risk patients with ASCVD are defined as having multiple major ASCVD events or one major ASCVD event and multiple other risk factors such as smoking, hypertension, diabetes, or persistent elevated LDL-C to name a few.¹ While unclear exactly how many patients are considered very high-risk, separate studies show a range of 26-58% of ASCVD patients may be classified as very high-risk.^2-3 The most recent ACC/AHA guideline recommends optimizing LDL-C management in very high-risk ASCVD patients with high-intensity statin therapy or maximally tolerated statin therapy.¹ The guidelines further recommend using an LDL-C threshold of 70 mg/dL (1.8 mmol/L) in very high-risk ASCVD patients when considering the addition of nonstatins to statin therapy.¹

• What percentage of your own secondary prevention patients would you classify as being very high-risk?


• Of those very high-risk patients, what percentage would you estimate are at goal utilizing statins alone?


• Do you feel that 70 mg/dL LDL-C is low enough to prevent additional ASCVD events or do you target even lower? Should ACC/AHA LDL-C guidelines be adjusted to provide an LDL-C goal ≤55 mg/dL, similar to ESC⁴?

References:

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24):3168-3209


2. Sajja A, Li HF, Spinelli KJ, et al. A simplified approach to identification of risk status in patients with atherosclerotic cardiovascular disease. American Journal of Preventive Cardiology 2021; (7): 100187


3. Colantonio LD, Shannon ED, Orroth KK, et al. Ischemic Event Rates in Very-High-Risk Adults. Journal of the American College of Cardiology, 2019; 74(20): 2496-2507


4. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2020; 41(1): 111–188

Very high-risk patients with ASCVD are defined as having multiple major ASCVD events or one major ASCVD event and multiple other risk factors such as smoking, hypertension, diabetes, or persistent elevated LDL-C to name a few.¹ While unclear exactly how many patients are considered very high-risk, separate studies show a range of 26-58% of ASCVD patients may be classified as very high-risk.^2-3 The most recent ACC/AHA guideline recommends optimizing LDL-C management in very high-risk ASCVD patients with high-intensity statin therapy or maximally tolerated statin therapy.¹ The guidelines further recommend using an LDL-C threshold of 70 mg/dL (1.8 mmol/L) in very high-risk ASCVD patients when considering the addition of nonstatins to statin therapy.¹

• What percentage of your own secondary prevention patients would you classify as being very high-risk?


• Of those very high-risk patients, what percentage would you estimate are at goal utilizing statins alone?


• Do you feel that 70 mg/dL LDL-C is low enough to prevent additional ASCVD events or do you target even lower? Should ACC/AHA LDL-C guidelines be adjusted to provide an LDL-C goal ≤55 mg/dL, similar to ESC⁴?

References:

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24):3168-3209


2. Sajja A, Li HF, Spinelli KJ, et al. A simplified approach to identification of risk status in patients with atherosclerotic cardiovascular disease. American Journal of Preventive Cardiology 2021; (7): 100187


3. Colantonio LD, Shannon ED, Orroth KK, et al. Ischemic Event Rates in Very-High-Risk Adults. Journal of the American College of Cardiology, 2019; 74(20): 2496-2507


4. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2020; 41(1): 111–188

Very high-risk patients with ASCVD are defined as having multiple major ASCVD events or one major ASCVD event and multiple other risk factors such as smoking, hypertension, diabetes, or persistent elevated LDL-C to name a few.¹ While unclear exactly how many patients are considered very high-risk, separate studies show a range of 26-58% of ASCVD patients may be classified as very high-risk.^2-3 The most recent ACC/AHA guideline recommends optimizing LDL-C management in very high-risk ASCVD patients with high-intensity statin therapy or maximally tolerated statin therapy.¹ The guidelines further recommend using an LDL-C threshold of 70 mg/dL (1.8 mmol/L) in very high-risk ASCVD patients when considering the addition of nonstatins to statin therapy.¹

• What percentage of your own secondary prevention patients would you classify as being very high-risk?


• Of those very high-risk patients, what percentage would you estimate are at goal utilizing statins alone?


• Do you feel that 70 mg/dL LDL-C is low enough to prevent additional ASCVD events or do you target even lower? Should ACC/AHA LDL-C guidelines be adjusted to provide an LDL-C goal ≤55 mg/dL, similar to ESC⁴?

References:

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 73(24):3168-3209


2. Sajja A, Li HF, Spinelli KJ, et al. A simplified approach to identification of risk status in patients with atherosclerotic cardiovascular disease. American Journal of Preventive Cardiology 2021; (7): 100187


3. Colantonio LD, Shannon ED, Orroth KK, et al. Ischemic Event Rates in Very-High-Risk Adults. Journal of the American College of Cardiology, 2019; 74(20): 2496-2507


4. Mach F, Baigent C, Catapano A, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). 2020; 41(1): 111–188