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LDL-C is a critical factor in the risk
of CV events

High LDL-C is a primary causal factor for the development of atherosclerosis and results in CV events1,2

The prevalence and extent of atherosclerosis increases with rising levels of LDL-C, independent of other risk factors. Elevated LDL-C and other lipids also account for the largest proportion of risk for CV events—independent of gender, ethnic group, and geographic region.

Lipids are one of the most critical, and modifiable, risk factors for a CV event2

INTERHEART: Assessed nine modifiable risk factors, which accounted for >90% of initial myocardial infarction risk worldwide; n = 15,152 patients and 14,820 controls in 52 countries.2

* Proportional reduction in population disease that would occur if exposure to a risk factor were reduced to an alternative ideal exposure scenario (eg, no tobacco use). Adjusted for all risk factors.2-4

Irregular consumption of fruits and vegetables.

More intensive LDL-C reductions dramatically reduce the risk of CV events1,5,6

Multiple studies have shown that you can further reduce the risk of a CV event in your patients with ASCVD by achieving greater reductions in their LDL-C. The risk of a CV event decreases proportionally to the reduction of LDL-C level.

The rate of CV events is directly correlated with LDL-C levels5,6
(Meta-analysis of major lipid secondary prevention statin trials)

Cholesterol Treatment Trialists’ Collaboration (CTTC) meta-analysis of major lipid secondary prevention statin trials conducted in 2010: median follow-up ~ 5 years, N = 169,138.5

Lower LDL-C levels are recommended for very high-risk ASCVD patients7,8

Patients with ASCVD at very high risk have CV events at an ~ 8x higher rate than patients with ASCVD who are not at very high risk, and the 2022 ACC ECDP recommends treating their LDL-C to < 55 mg/dL. Once you’ve established your patients’ risk status, consider if treatment intensification is needed to help lower the risk of an event.

Retrospective cohort study analyzed data from US adults included in the Prognos LDL-C database from January 1, 2016 to June 30, 2018. Patients were ≥ 18 years old and had ≥ 2 non-ancillary medical claims in the linked databases at least 30 days apart. The study was conducted in two stages: 1) identification of patients with ASCVD who met the definition of very high risk and a matched cohort of patients with ASCVD who are not at very high risk using the incidence density sampling approach, 2) estimation of the occurrence of major CV events.7

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Identify your patients with ASCVD who are very high risk

ACC = American College of Cardiology; ASCVD = atherosclerotic cardiovascular disease; ECDP = Expert Consensus Decision Pathway; IS = ischemic stroke; MI = myocardial infarction; UA = unstable angina hospitalization.

  • References

    1. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38:2459-2472.
    2. Yusuf S, Hawken S, Ôunpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952.
    3. World Health Organization. Population attributable fraction. www.who.int/data/gho/indicator-metadata-registry/imr-details/1287. Accessed July 25, 2024.
    4. Rockhill B, Newman B, Weinberg C. Use and misuse of population attributable fractions. Am J Public Health. 1998;88:15-19.
    5. 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.
    6. Raymond C, Cho L, Rocco M, Hazen SL. New cholesterol guidelines: worth the wait? Cleve Clin J Med. 2014;81:11-19.
    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. 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.