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MOST ASCVD PATIENTS AT VERY HIGH RISK may NEED MORE INTENSIVE LDL-C MANAGEMENT1-7

Elevated lipids are one of the strongest predictors of a CV event, and one of the most modifiable risk factors.8,9 It’s important to consider lifestyle modifications and which treatments may be needed to help patients with ASCVD at very high risk achieve the ACC ECDP–recommended LDL-C level of < 55 mg/dL.1

Lipids are one of the most important modifiable risk factors10

Population-attributable risk fractions of the 10-year incidence of cardiovascular disease*
pupulation-attributable-risk-sm

* First possible or definite CHD event, possible or definitive stroke event, coronary revascularization, CHD death, stroke death, unclassifiable death.

† Population-attributable fraction is an estimate of the proportion of an outcome that could be prevented if the value of a risk factor were replaced by a hypothetical, ideal value.

‡ Non-HDL-C.

2022 ACC Expert Consensus Decision Pathway recommendation for ASCVD patients at very high risk:1,§

Consider initiating nonstatin therapies after evaluating the following:
  • Optimizing lifestyle
  • Adherence to guideline- recommended statin therapy
  • Risk factor control
  • Statin-associated side effects
  • Escalating to high-intensity statins if not already taking
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LDL-C < 55 mg/dL

≥ 50% LDL-C

REDUCTION FROM BASELINE

§Very high-risk patients have a history of multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions, as previously defined in the 2018 AHA/ACC Multisociety cholesterol management guideline.1,9

Secondary prevention statin trials show that the lower the LDL-C, the lower the risk of CV events

Meta-analysis of major lipid secondary prevention statin trials4,11
event-rate-in-secondary-prevention-trials

CTTC meta-analysis of major lipid secondary prevention statin trials conducted in 2010: median follow-up ~ 5 years, N = 169,138.

CTTC = Cholesterol Treatment Trialists’ Collaboration; CV = cardiovascular; LDL-C = low-density lipoprotein cholesterol.

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You have the power to help patients who are living in the red

Consider additional therapy for patients with ASCVD at very high risk who are not achieving recommended LDL-C < 55 mg/dL

Find helpful resources
References: 1. 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. 2. Chen C-C, Rane PB, Hines DM, Patel J, Harrison DJ, Wade RL. Low-density lipoprotein cholesterol outcomes post-non-PCSK9i lipid-lowering therapies in atherosclerotic cardiovascular disease and probable heterozygous familial hypercholesterolemia patients. Ther Clin Risk Manag. 2018;14:2425-2435. 3. Cannon CP, de Lemos JA, Rosenson RS, et al; for the GOULD Investigators. Use of lipid-lowering therapies over 2 years in GOULD, a registry of patients with atherosclerotic cardiovascular disease in the US. JAMA Cardiol. 2021;6:1060-1068. 4. 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. 5. 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. 6. Boekholdt SM, Hovingh GK, Mora S, et al. Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. J Am Coll Cardiol. 2014;64:485-494. 7. Fonarow GC, Kosiborod MN, Rane PB, et al. Patient characteristics and acute cardiovascular event rates among patients with very high-risk and non-very high-risk atherosclerotic cardiovascular disease. Clin Cardiol. 2021;44:1457-1466. 8. Fernández-Friera L, Fuster V, López-Melgar B, et al. Normal LDL-cholesterol levels are associated with subclinical atherosclerosis in the absence of risk factors. J Am Coll Cardiol. 2017;70:2979-2991. 9. 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. 2018;73:e285-e350. 10. Magnussen C, Ojeda FM, Leong DP, et al: Global Cardiovascular Risk Consortium. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med. 2023;389:1273-1285. 11. Baigent C, Blackwell L, Emberson J, et al; Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376:1670-1681.