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Statin therapy is the recommended treatment for lowering low-density lipoprotein cholesterol (LDL-C)and reducing atherosclerotic cardiovascular disease (ASCVD) risk. Unfortunately, many clinicians fail to help their patients achieve evidence-based and guidelinerecommended LDL-C targets and underutilize effective LDL-lowering therapies, including ezetimibe and PCSK9 inhibitors, even among the highest risk patients. As a result, a heavy, unmitigated burden of
cardiovascular risk persists. More education for healthcare providers and patients is urgently needed to address this problem.
PCSK9 inhibitor therapy has been shown to lower LDL- and ASCVD events in patients who cannot take statins. For individuals at high risk for ASCVD events, research shows that the goal should not just be lowering LDL-C, but helping patients achieve the lowest LDL-C possible. Several large trials have demonstrated the efficacy of PCSK9 inhibitors in addition to statin therapy for reduction of both LDL-C and ASCVD risk.
The GLAGOV trial demonstrated the efficacy of evolocumab, when added to statin therapy, in reducing the progression of atherosclerosis measured by serial intravascular ultrasound. This trial was followed by the FOURIER Cardiovascular Outcomes trial in more than 27,000 patients with stable ASCVD where evolocumab reduced the primary endpoint of atherosclerotic events by 15%, without significant safety differences between treatment groups. Subgroup analyses of FOURIER suggested greater benefits seen in those with longer exposure to evolocumab, including those with recent acute coronary syndrome (ACS), multiple myocardial infarctions, multivessel coronary artery disease, peripheral arterial disease, and the subgroup who achieved very low LDL-C levels of below 0.3 mmol/L (10 mg/dL). Finally, the ODYSSEY Cardiovascular Outcomes trial testing alirocumab in subjects with recent (within 1 year) ACS demonstrated a 15% relative risk reduction in the primary composite outcome, as well as a significant reduction in total mortality.
In statin-intolerant patients who have genetic cholesterol problems or aggressive cardiovascular disease, it is important to start them on a PCSK9 inhibitor as soon as possible. The GAUSS-34 randomized trial of patients with confirmed, lifestyle-limiting statin intolerance showed that PCSK9 inhibitor therapy yielded excellent LDL-C reduction with a low rate of muscle-related adverse effects and a good overall side effect profile.
The results of these trials show that the addition of PCSK9 inhibitors to traditional statin therapy in high-risk patients, or used alone in patients who are statin intolerant, is advantageous. Despite this evidence, many clinicians still struggle to prescribe appropriate treatment. This is a result of:
To address these important issues, NATF and ScientiaCME have developed a series of educational activities. This activity is focused on helping clinicians identify which patients would benefit from PCSK9 inhibitors.
Physicians, nurse practitioners, physician assistants, pharmacists, and other clinicians specializing in:
This activity is supported by educational funding provided by Amgen.
The activity is available to learners free of charge.
Release Date: November 22, 2022 -- Expiration Date: November 22, 2023
Faculty: Various Multiple Faculty,
By the end of the session the participant will be able to:
ACCME Activity #202402925
ACCREDITATION FOR THIS COURSE HAS EXPIRED. YOU MAY VIEW THE PROGRAM, BUT CME / CE IS NO LONGER AVAILABLE AND NO CERTIFICATE WILL BE ISSUED.
Jorge Plutzky, MD, Director, Preventive Cardiology, Brigham and Women’s Hospital, Boston, MA: Paid consultant -- Alnylam, Altimmune, Amgen, Esperion, Merck, MJ Health Lifesciences, Novo Nordisk; Grants: Boehringer Ingelheim, Novartis
Individuals with no conﬂicts of interest to disclose:
Anum Saeed, MD, Assistant Professor, University of Pittsburgh Medical Center
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