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Combination Lipid-Lowering Therapies for the Prevention of Recurrent Cardiovascular Events
Sara Lee1, Christopher P Cannon2
1Temple University School of Pharmacy, 1625 Annin St, Philadelphia, PA, 19146, USA.
Insights
Non-statin medications like ezetimibe and PCSK9 inhibitors significantly reduce cardiovascular events in patients already on statins. Recent trials confirm their role in cardiovascular prevention, guiding updated treatment pathways.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- The 2013 American College of Cardiology/American Heart Association (ACC/AHA) Lipid guidelines created confusion regarding non-statin medications for cardiovascular prevention.
- Recent large-scale clinical trials have provided crucial data on the efficacy of these agents.
Purpose of the Study:
- To clarify the role of non-statin medications in cardiovascular disease (CVD) prevention.
- To review recent evidence supporting the use of non-statins in conjunction with statins.
Main Methods:
- Analysis of recent large clinical trials, including IMPROVE IT, FOURIER, and ODYSSEY-OUTCOMES.
- Review of current expert consensus guidelines, such as the 2017 ACC Expert Consensus Decision Pathway.
Main Results:
- Lowering LDL cholesterol with non-statin medications, such as ezetimibe and PCSK9 inhibitors, demonstrably reduces cardiovascular events in patients on statin therapy.
- These findings support the addition of ezetimibe and/or PCSK9 inhibitors to statins for further LDL-C reduction based on patient risk.
Conclusions:
- Non-statin therapies are now established as valuable tools for cardiovascular risk reduction.
- Current treatment recommendations emphasize a stepwise approach, initiating statins and adding non-statins as needed to achieve target LDL-C levels.
Purpose Of Review:
There has been confusion following the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Lipid guidelines on the role of non-statin medications for cardiovascular prevention.
Recent Findings:
Several recent large trials have also now shown that lowering LDL with non-statins reduces cardiovascular events. In ASCVD patients on statins, adding ezetimibe or a PCSK9 inhibitor led to reductions in CV events in the IMPROVE IT, FOURIER, and most recently the ODYSSEY-OUTCOMES trials. Additional novel therapies reducing LDL and other atherogenic lipoproteins are in development during this exciting time in this field. With recent evidence, the 2017 ACC Expert Consensus Decision pathway calls for initial therapy with statins, monitoring LDL levels, and then adding ezetimibe and/or PCSK9 inhibitors to further lower LDL-C to targets based on the patient's risk.
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