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Manage LDL-C for your secondary prevention ASCVD patients 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 secondary prevention ASCVD patients at very high risk to LDL-C < 55 mg/dL and/or ≥ 50% reduction from baseline.4

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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

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* 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.

Despite the use of statin therapy, residual CV risk remains5-15

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)
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†Mean or median LDL-C after treatment.

Despite treatment with a high-intensity statin ± ezetimibe, most secondary prevention patients at very high risk have an LDL-C at or above 55 mg/dL.16,†

72% with high-intensity statin ezetimibe icon
†Data included patients diagnosed with ASCVD between August 2018 to August 2023. This consisted of over 16 million patients with very high risk (VHR) ASCVD. 626,193 VHR ASCVD patients had an ASCVD event between August 2018 and August 2022 and valid LDL-C value within 12 months following most recent event. Measures on treatment based on LDL-C levels included patients with an ASCVD event between November 2018 and May 2023. Those identified as treated did not receive any additional nonstatin LLTs other than ezetimibe. The patient’s prescription activity and LDL-C levels were monitored for 3 months prior to and 3 months following their most recent event, respectively. Very high risk was defined in alignment with the 2018 AHA/ACC/Multi-society guidelines; however, persistently elevated LDL-C ≥100 mg/dL was not included due to data availability.

LDL-C lowering medications recommended by the 2022 ACC ECDP for secondary prevention ASCVD patients at very high risk5

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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. Heart 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.