Page 2 - reflections_newsletter

REFLECTIONS
Dyslipidaemia
Dyslipidemia Global Newsletter #1

Low-density lipoprotein cholesterol (LDL-C) goals are outlined A new section in the guidelines is devoted to communication
for various age and risk groups. of risk in the shared-decision-making process with patients,
including understanding their risk, anticipated risk reduction with
Dyslipidaemia
preventive actions, the pros and cons of intervention, and their
RECOMMENDATIONS own priorities.

Patient: Apparently healthy persons <70 years at very high risk Intensity of lipid-lowering treatment
• LDL-C goal of <1.4 mmol/L (55 mg/dL) Treatment Average LDL-C reduction
• LDL-C reduction of =50% from baseline Moderate-intensity statin ˜30%
High-intensity statin ˜50%
Patient: Apparently healthy persons <70 years at high risk High-intensity statin plus ezetimibe ˜65%
• LDL-C goal of <1.8 mmol/L (70 mg/dL)
• LDL-C reduction of =50% from baseline PCSK9 inhibitor ˜60%
PCSK9 inhibitor plus high-intensity statin ˜75%
Patient: Established atherosclerotic cardiovascular disease PCSK9 inhibitor plus high-intensity statin plus ezetimibe ˜85%
(ASCVD), lipid-lowering treatment
• LDL-C goal of <1.4 mmol/L (55 mg/dL)
• LDL-C reduction of =50% from baseline CLICK HERE
FOR THE LINK TO FULL ARTICLE
Patient: Type 2 diabetes at very high risk (e.g., with established
ASCVD and/or severe target organ damage [TOD])
• LDL-C goal of <1.4 mmol/L (55 mg/dL)
• LDL-C reduction of =50% from baseline

Patient: Type 2 diabetes >40 years at high risk
• LDL-C goal of <1.8 mmol/L (70 mg/dL)
• LDL-C reduction of =50% from baseline

Practical guidance for combination lipid-modifying therapy in high- and very-high-
risk patients: A statement from a European Atherosclerosis Society Task Force.
Averna M, et al. Atherosclerosis. 2021;325:99-109.

This practical guidance from The European Atherosclerosis Society Task Force includes step-by-step algorithms for managing high
LDL-C levels in ASCVD patients, managing familial hypercholesterolemia (FH) patients without ASCVD, and managing high- and
very-high-risk patients with elevated triglycerides
Patients with ASCVD with elevated LDL-C NO: Increase (TG). The 2019 European Society of Cardiology/
statin intensity European Atherosclerosis Society (ESC/
(if not on HI statin*)
LDL-C =1.8 mmol/L
YES (=70 mg/dL)? YES: Switch to Statin intolerance? EAS) guidelines for dyslipidemia management
HI statin* and Consider emphasized the need to lower LDL-C as much as
and ezetimibe ezetimibe ±
STEP 1 On statin? bempedoic acid possible to prevent ASCVD and recommended
NO: Start HI statin*
LDL-C =2.6 mmol/L combination therapy to achieve LDL-C goals as
NO (=100 mg/dL)? YES: Start HI statin*
and ezetimibe early as possible.
Monitor LDL-C after 4-6 weeks
On HI statin* Not at LDL-C goal? Add ezetimibe Combination therapy of high-intensity (HI) statin
+ ezetimibe, HI statin + proprotein convertase
STEP 2 Not at LDL-C goal and
On HI statin* at least one risk modifier? Add a subtilisin/kexin type 9 inhibitor (PCSK9i), or HI
+ ezetimibe • Polyvascular disease or PAD PCSK9 inhibitor
• Post-CABG statin + PCSK9 + ezetimibe can, on average,
• Diabetes mellitus reduce LDL-C by 65%–85%, according to the
• Lp(a) >50 mg/dL
• Familial hypercholesterolaemia 2021 ESC guidelines (see above).
* HI statin: high-intensity statin or maximally tolerated statin therapy

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