Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Practice Guidelines

Background:

• Overt atherosclerotic cardiovascular disease (ASCVD) requires aggressive lipid lowering.
• Diagnostic imaging can reveal previously unknown ASCVD in patients with ambiguous symptoms or for risk assessment.
• Current guidelines lack clear recommendations for intensive lipid management in these specific situations.

Purpose of the Study:

• To explore physicians' perceptions of the appropriateness of achieving lipid goals and using proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i).
• To assess how the detection of previously unknown ASCVD influences these perceptions.
• To identify gaps in current guidelines regarding lipid management.

Main Methods:

• A questionnaire-based study was conducted with hypothetical patient cases.
• Cases varied by cardiovascular (CV) risk, presence of chronic kidney disease (CKD) or type 2 diabetes mellitus (T2DM), angina symptoms, and ASCVD detection (advanced, subclinical, or none).
• Physicians rated the appropriateness of lipid management strategies on a 1-9 scale.

Main Results:

• Aggressive lipid lowering and PCSK9i use were deemed appropriate for patients with T2DM, moderate/high CV risk, or CKD when advanced ASCVD was detected.
• PCSK9i use was considered possibly appropriate in most other cases where ASCVD was identified.
• Physicians' decisions were significantly influenced by the detection of subclinical or advanced ASCVD.

Conclusions:

• Physicians' perception of appropriate lipid goal attainment and PCSK9i access is strongly influenced by the discovery of previously unknown ASCVD.
• These findings highlight a discrepancy between clinical practice and current guideline indications for PCSK9i.
• Further research is needed to address these common clinical scenarios and refine treatment guidelines.