Evidence, Guidelines, and Gut Checks: Musings on Entering the Post-Statin Era of Lipid Management.

This viewpoint describes the results of a survey administered to 55 physicians who are key opinion leader experts in dyslipidemia management and thoroughly knowledgeable about current guidelines and emerging therapies. The purpose was to determine the level of low density lipoprotein-cholesterol (LDL-C) achieved with maximally tolerated statin monotherapy that would trigger a preference by most for use of the soon to be available proprotein convertase subtilisin/kexin type 9 inhibitor as the next add-on agent. Because current guidelines suggest a uniform LDL-C goal when treating patients meeting guideline indications for therapy, it was expected that the size of the gap between LDL-C goal and LDL-C attained with maximally tolerated statins would uniformly dictate when proprotein convertase subtilisin/kexin type 9 inhibitors would be desired. This expectation, however, was not met. In particular, the results suggest that primary prevention patients and patients with chronic kidney disease do not appear to represent high priority circumstances for achieving even the current LDL-C goal despite existing guidelines. Implications for future guidelines in the post-statin era are discussed.