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4yr
Comparison of Evolocumab and Ezetimibe, Both Combined with Statin Therapy, for Patients with Recent Acute Coronary Syndrome: A Cost-Effectiveness Analysis from the Chinese Healthcare Perspective - PubMed

Comparison of Evolocumab and Ezetimibe, Both Combined with Statin Therapy, for Patients with Recent Acute Coronary Syndrome: A Cost-Effectiveness Analysis from the Chinese Healthcare Perspective - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/35467312/

doi: 10.1007/s10557-021-07276-x. Online ahead of print. 1 The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, China. 2 School of Pharmacy, Hangzhou Medical College, Hangzhou, China....


Conclusion: Compared with ezetimibe statins, the combination of evolocumab statins was found to be cost-effective at a threshold of 217,341 yuan (three times per capita GDP, 2020) in patients with recent ACS events in China.

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4yr
Approach to patients with elevated low-density lipoprotein cholesterol levels - PubMed

Approach to patients with elevated low-density lipoprotein cholesterol levels - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/35487874/

Elevated low-density lipoprotein cholesterol (LDL-C) levels increase the risk of atherosclerotic cardiovascular disease (ASCVD) and lowering LDL-C levels reduces the risk of ASCVD. In patients with elevated LDL-C levels it...


Conclusion: Specifically, we discuss evidence indicating that the sooner one initiates therapy the better and the greater the reduction in LDL-C the better. Additionally, the higher the LDL-C level and the higher the risk of ASCVD, the greater the benefits of treatment. Using these principles will help in making decisions regarding the...

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4yr
The National Cardiovascular Data Registry Data Quality Program 2020: JACC State-of-the-Art Review - PubMed

The National Cardiovascular Data Registry Data Quality Program 2020: JACC State-of-the-Art Review - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/35483759/

The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the quality...


Relevance: The National Cardiovascular Data Registry is a group of registries maintained by the American College of Cardiology Foundation. These registries are used by a diverse constituency to improve the quality and outcomes of cardiovascular care, to assess the safety and effectiveness of new therapies, and for research.

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4yr
Atherosclerotic cardiovascular disease burden in patients with familial hypercholesterolemia: interpretation of data on involvement of different vascular beds - PubMed

Atherosclerotic cardiovascular disease burden in patients with familial hypercholesterolemia: interpretation of data on involvement of different vascular beds - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/35485652/

Familial hypercholesterolemia (FH) is a monogenic, autosomal dominant disorder that results in a rise of low‑density lipoprotein cholesterol (LDL‑C) and markedly increased risk of premature atherosclerotic cardiovascular disease. FH is...


Conclusion: Providing a systematic characteristic of patients with FH with respect to the presence and extent of atherosclerotic lesions in different vascular beds may have implications for daily practice not only for patients with FH but also for a larger number of patients with very high plasma LDL‑C concentrations.

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4yr
Cardiovascular Disease Risk Assessment & LDL-C Goal

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
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  • 4yr
    approximately 50% of my pts are considered high risk, LDL goal for my pts with diabetes is <50, approximately 50% of my pts will reach the goal with statin monotherapy, Show More
  • 4yr
    There are only a few patients who have their first ASCVD event in the absence of multiple risk factors -- I think perhaps only about 20%; meaning that virtually all Show More

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