Xiaoming Jia1, Mahmoud Al Rifai2,3, Yochai Birnbaum4, Sidney C Smith5, Salim S Virani6,7,8. 1. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 2. Department of Medicine, University of Kansas School of Medicine, Wichita, KS, USA. 3. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA. 4. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. 5. Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA. 6. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. virani@bcm.edu. 7. Health Policy, Quality and Informatics Program, Health Services Research and Development Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. virani@bcm.edu. 8. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. virani@bcm.edu.
Abstract
PURPOSE OF REVIEW: The 2018 ACC/AHA Multisociety blood cholesterol guidelines provide updated recommendations based on contemporary evidence on the management of serum cholesterol for the prevention of atherosclerotic cardiovascular disease (ASCVD) events. This review discusses clinically important topics in the new guidelines related to secondary ASCVD prevention. RECENT FINDINGS: Since the 2013 ACC/AHA blood cholesterol guidelines, several large randomized control trials involving ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab) have been published. The trials provided evidence that these non-statin, LDL-cholesterol lowering agents are efficacious in reducing risk for ASCVD events in patients with clinical ASCVD. The 2018 guidelines incorporate these new findings into updated clinical recommendations on therapeutic strategies related to the use of ezetimibe and PCSK9 inhibitors. The guidelines also recommend risk stratification of secondary prevention patients to identify those at very high-risk of ASCVD events as these patients would derive the most absolute risk reduction from the addition of non-statin therapies. While high-intensity statins remain the first-line treatment to prevent recurrent ASCVD events in secondary prevention patients, ezetimibe and PCSK9 inhibitors are evidence-based non-statin agents that can be used when residual on top of maximally tolerated statin therapy in patients deemed to be at very-high risk of recurrent ASCVD events.
PURPOSE OF REVIEW: The 2018 ACC/AHA Multisociety blood cholesterol guidelines provide updated recommendations based on contemporary evidence on the management of serum cholesterol for the prevention of atherosclerotic cardiovascular disease (ASCVD) events. This review discusses clinically important topics in the new guidelines related to secondary ASCVD prevention. RECENT FINDINGS: Since the 2013 ACC/AHA blood cholesterol guidelines, several large randomized control trials involving ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab) have been published. The trials provided evidence that these non-statin, LDL-cholesterol lowering agents are efficacious in reducing risk for ASCVD events in patients with clinical ASCVD. The 2018 guidelines incorporate these new findings into updated clinical recommendations on therapeutic strategies related to the use of ezetimibe and PCSK9 inhibitors. The guidelines also recommend risk stratification of secondary prevention patients to identify those at very high-risk of ASCVD events as these patients would derive the most absolute risk reduction from the addition of non-statin therapies. While high-intensity statins remain the first-line treatment to prevent recurrent ASCVD events in secondary prevention patients, ezetimibe and PCSK9 inhibitors are evidence-based non-statin agents that can be used when residual on top of maximally tolerated statin therapy in patients deemed to be at very-high risk of recurrent ASCVD events.
Authors: Mahmoud Al Rifai; Xiaoming Jia; Mouaz H Al-Mallah; Michael D Miedema; Seth S Martin; Salim S Virani Journal: Curr Atheroscler Rep Date: 2019-05-24 Impact factor: 5.113
Authors: Michelle Partogi; Simon Gaviria-Valencia; Mateo Alzate Aguirre; Nancy J Pick; Huzefa M Bhopalwala; Barbara A Barry; Vinod C Kaggal; Christopher G Scott; Maya E Kessler; Matthew M Moore; Jay D Mitchell; Rajeev Chaudhry; Robert P Bonacci; Adelaide M Arruda-Olson Journal: J Med Internet Res Date: 2022-08-22 Impact factor: 7.076