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Expert Opinion on Targeted Lipid Control for Very-high-risk Indian Patients: Bridging the Gap in Real-world Practice
Kausik Ray1, Upendra Kaul2, Srinivasa Rao3
1Department of Primary Care Public Health, Imperial College London London, UK.
Abstract:
Despite robust clinical guidelines and the availability of potent lipid-lowering therapies (LLTs), many very-high-risk dyslipidaemia patients fail to achieve target LDL cholesterol (LDL-C) levels, primarily due to poor adherence and delayed treatment intensification. Two virtual meetings were convened involving a panel of senior cardiologists. Insights were synthesised into an expert framework, developed through polling and collective inputs from expert. The panel strongly recommends LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients. A 2 × 2 matrix was proposed to tailor LLTs based on patient adherence and CV risk, emphasising early initiation of combination therapy and use of inclisiran in non-adherent patients. Patients with very high baseline LDL-C require combination therapy with high-intensity statins, with add-on proprotein convertase subtilisin/kexin type 9 inhibitors, which significantly enhances LDL-C reduction and improves goal attainment. A simplified decisionmaking algorithm that accounts for adherence and promotes timely treatment intensification with combination LLTs needs to be implemented to effectively lower LDL-C in very-high-risk Indian patients in clinical practice.
Insights
Achieving target LDL cholesterol (LDL-C) in very-high-risk patients requires intensified treatment. Experts recommend a <55 mg/dl LDL-C goal, emphasizing adherence-based strategies and combination therapies for optimal lipid-lowering.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Despite guidelines and therapies, many very-high-risk dyslipidemia patients don't reach LDL cholesterol targets.
- Poor adherence and delayed treatment intensification are key barriers to achieving lipid goals.
Purpose of the Study:
- To develop an expert framework for optimizing lipid-lowering therapies (LLTs) in very-high-risk dyslipidemia patients.
- To propose strategies for timely treatment intensification and improved LDL-C goal attainment.
Main Methods:
- Two virtual meetings convened a panel of senior cardiologists.
- Insights were synthesized into an expert framework using polling and collective inputs.
- A 2x2 matrix was proposed to tailor LLTs based on adherence and cardiovascular risk.
Main Results:
- Recommended LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients.
- Emphasized early initiation of combination therapy and use of inclisiran for non-adherent patients.
- High-intensity statins with PCSK9 inhibitors are crucial for very high baseline LDL-C.
Conclusions:
- A simplified decision-making algorithm is needed to account for adherence and promote timely treatment intensification.
- Implementing combination LLTs is essential for effectively lowering LDL-C in very-high-risk Indian patients.
- Tailoring LLTs based on adherence and risk stratification can improve goal attainment.
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