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Conclusion/Relevance: “Recommendations attempt to provide practical guidance for clinicians and patients regarding the use of nonstatin therapies to further reduce ASCVD risk in situations not covered by the guideline until such time as the scientific evidence base expands and cardiovascular outcomes trials are completed with newer agents for ASCVD risk reduction.”

  • September 07, 2022
    This is fantastic and very timely. Note the absence of niacin and fibrates, which I am still seeing prescribed. It is good to have a gathering of data on which non-statin therapies are worth using and what backs them up. Looking forward to the newest drugs showing real MACE reductions, hopefully.
  • September 07, 2022
    Key Points
    • Source: Journal of the American College of Cardiology
    • Conclusion: “This ECDP [Expert Consensus Decision Pathway] addresses current gaps in care for LDL-C lowering to reduce ASCVD risk and provides recommendations that build on the evidence base established by the 2013 ACC/AHA and 2018 AHA/ACC/multisociety cholesterol guidelines. The algorithms endorse the 4 evidence-based patient management groups identified in the guidelines and assume that the patient is currently taking or has attempted to take a statin, given that this is the most effective initial therapy.”
    • Various non-statins have been effective at lowering LDL-C ever since the publication of the 2018 AHA/ACC/multisociety cholesterol guidelines
    • Large controlled cardiovascular outcomes trials are under way for bempedoic acid and inclisiran.
    • Currently, much remains to be determined regarding guidance with non-statin treatments.
    • “If additional LDL-C lowering is desired after the addition of ezetimibe and/or a PCSK9 mAb (<50% reduction in LDL-C or LDL-C ≥70 mg/dL or non–HDL-C ≥100 mg/dL), it is reasonable to engage in a clinician-patient discussion with consideration of the net benefit of bempedoic acid,” the authors wrote. “This medication may be especially useful in patients with statin-associated myalgias.”
    • Bempedoic acid results in an average additional reduction of LDL-C by 17%. It is effective in patients who are statin intolerant or intolerant of other non-statins, as well as in patients who desire to not use injectable medications. Caution should be employed when using bempedoic acid in those with a history of gout or tendon rupture.