Low-density lipoprotein cholesterol lowering therapy for the secondary prevention of atherosclerotic cardiovascular disease

Abstract

Atherosclerotic cardiovascular disease (ASCVD) is highly prevalent and a major contributor to morbidity and mortality worldwide. Elevated blood cholesterol is a key driver of risk for atherosclerotic events, and patients with established ASCVD comprise a specific high-risk population in which low-density lipoprotein cholesterol (LDL-C) lowering therapy is strongly endorsed by multiple guidelines. An increasing number of medications across several pharmacologic classes are available today in clinical practice. Therefore, guidance on the appropriate use of these interventions is necessary for cost-effective solutions to managing residual atherothrombotic risk. In this review we summarize the key evidence supporting LDL-C lowering as described in the most recent 2018 multi-society Blood Cholesterol Guidelines, and provide a framework for optimizing LDL-C lowering therapy in secondary prevention populations.

Perfil epidemiológico e laboratorial de pacientes diabéticos tipo 2 em um centro de referência de Aracaju/SE

“…Os exercícios aeróbios como caminhada, corrida, ciclismo, natação, promovem a redução dos triglicerídeos, aumenta os níveis de HDL, e o índice de LDL não sofre alteração significativas. Por isso, recomenda-se que o mesmo seja associado a uma dieta saudável e, caso haja sobrepeso ou obesidade, sugere-se perda de peso (Pignone, 2023;Stefanick et al, 1998).…”

Canadian Cost-Effectiveness of Coronary Artery Calcium Screening Based on the Multi-Ethnic Study of Atherosclerosis

“…The mean cost of an incident CVD event was the weighted average using the relative frequencies of event types in MESA. We determined the average generic unit cost for high-intensity dose statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) 4 , 33 , 34 , 35 as $0.21/tablet per the Alberta Drug Formulary Drug Benefit List. 34 This excludes pharmacy markups and dispensing fees ( Supplemental Table 12 ).…”

Pharmacotherapeutics for dyslipidemia management

“…PCSK9 inhibitors are thought to be more effective than second-line treatment in combination with statin therapy; however, because of their high cost, administration via injection, and lack of long-term safety data, NPs might wish to consider a trial of ezetimibe with statins prior to introducing PCSK9 inhibitors. 1,42,43 It is important to note as well that PCSK9 inhibitors may not be covered by insurance or may not be approved by insurance unless an ezetimibe trial has been completed. 1,44 In such cases, if the patient has still not reached the target LDL-C level with combination ezetimibe and statin therapy, then PCSK9 inhibitors may be used.…”

“…PCSK9 inhibitors may also be used as third-line treatment for some individuals for whom traditional first- and second-line therapies were insufficiently effective. PCSK9 inhibitors are thought to be more effective than second-line treatment in combination with statin therapy; however, because of their high cost, administration via injection, and lack of long-term safety data, NPs might wish to consider a trial of ezetimibe with statins prior to introducing PCSK9 inhibitors 1,42,43. It is important to note as well that PCSK9 inhibitors may not be covered by insurance or may not be approved by insurance unless an ezetimibe trial has been completed 1,44.…”