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Manage LDL-C for your patients with ASCVD who are at very high risk of a CV event

Lower LDL-C is better for patients with ASCVD

Cholesterol guidelines have consistently lowered their recommended level of LDL-C over time in recognition of the clinical benefit to reduce the risk of CV events for patients with ASCVD.1-3

The 2022 ACC ECDP currently recommends treating patients with ASCVD at very high risk to LDL-C < 55 mg/dL and/or ≥ 50% reduction from baseline.4

If your PATIENTS WITH ASCVD AT VERY HIGH RISK HAVE LDL-C THAT IS too high with statins alone, the 2022 ACC ECDP recommends:4

manage-ldl-c

* After evaluating the optimization of lifestyle, adherence to guideline-recommended statin therapy, risk factor control, statin associated side effects, and escalating to high-intensity statin if not already taken.

Statins alone may not sufficiently reduce your patients’ risk of another CV event5

Landmark statin trials demonstrated that even patients who achieve LDL-C of 62-81 mg/dL remain at risk for future CV events. Adding nonstatin therapy may be required to address your patients’ treatment needs.

  • Statin therapy vs
    placebo
  • Statin therapy (low/moderate intensity
    
vs high intensity)

Residual CV event risk remains despite the use of statin therapy5-11

graph-8

Residual risk remains high even in patients receiving high-intensity statin therapy12-15

‡Mean or median LDL-C after treatment.

Despite lipid-lowering treatment, most patients with ASCVD at very high risk do not have an LDL-C level of < 55 mg/dL16

Low percent of patients receiving statins ± ezetimibe achieve
LDL-C < 55 mg/dL

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20%with low to
moderate
intensity statin

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26% with high-intensity statin

LDL-C lowering medications recommended by the 2022 ACC ECDP for patients with very high-risk ASCVD4

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Learn about a nonstatin option

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Find additional resources to support your patients

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ACC = American College of Cardiology; ASCVD = atherosclerotic cardiovascular disease; ECDP = expert consensus decision pathway; mAb = monoclonal antibody.

  • References

    1. Masana L, Girona J, Ibarretxe D, et al. Clinical and pathophysiological evidence supporting the safety of extremely low LDL levels—the zero-LDL hypothesis. J Clin Lipidol. 2018;12:292-299.
    2. 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;73:3168-3209.
    3. Mach F, Baigent C, et al ; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111-188.
    4. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC Expert Consensus Decision Pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80:1366-1418.
    5. Sampson UK, Fazio S, Linton MF. Residual cardiovascular risk despite optimal LDL cholesterol reduction with statins: the evidence, etiology, and therapeutic challenges. Curr Atheroscler Rep. 2012;14:1-10.
    6. Scandinavian Simvastatin Survival Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-1389.
    7. Sacks FM, Et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001-1009.
    8. The Long-Term Intervention With Pravastatin in Ischaemic Disease Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-1357.
    9. Heat Protection Study Collaborative Group. MRC/BHF heart protection study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.
    10. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk of vascular disease (prosper): a randomised controlled trial. Lancet. 2002;360:1623-1630.
    11. Knopp RH, D'Emden M, Smilde JG, et al. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes. Diabetes Care. 2006;29:1478-1485.
    12. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387-2397.
    13. Wiviott SD, Cannon CP, Morrow DA, Ray KK, Pfeffer MA, Braunwald E; PROVE IT-TIMI 22 Investigators. Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy: a PROVE IT-TIMI 22 substudy. J Am Coll Cardiol. 2005;46:1411-1416.
    14. Pedersen TR, Faergeman O, Kastelein JJP, et al. High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA. 2005;294:2437-2445.
    15. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425-1435.
    16. Data on file, Amgen; 2023.