In 2022, the American College of Cardiology (ACC) published its expert consensus decision pathway on the role of nonstatin therapy for lowering LDL-C values to manage ASCVD. In view of net favorable clinical benefit, the ACC recommends nonstatin therapy for patients with ASCVD who are at very high risk for future events if their LDL-C level remains at or above 55 mg/dL while receiving maximally tolerated statins.
According to the ACC, these patients are at risk if they have already experienced multiple major events or they have a history of 1 major event and multiple high-risk conditions.
As defined by the AAC, major ASCVD events include:
- ACS within the past 12 months
- Prior myocardial infarction (other than ACS as above)
- Prior ischemic stroke
- Symptomatic PAD (history of claudication, with ABI <0.85 or prior revascularization/amputation)
Similarly, the ACC identifies as high-risk conditions as:
- Age ≥65 years
- Heterozygous familial hypercholesterolemia
- Prior CABG surgery or PCI (outside of the major ASCVD events)
- Diabetes
- Hypertension
- CKD (eGFR, 15-59 mL/min/1.73m2)
- Current cigarette smoking
- Persistently elevated LDL-C (≥100 mg/dL) despite maximally tolerated statin therapy and ezetimibe
- Prior CHF
Most patients who have experienced a major ASCVD event such as the ones described above could benefit from an LDL-C reduction of 50% or more and an LDL-C level below 55 mg/dL.
Do you aim for an LDL-C level below 55 mg/dL in your patients who have experienced a major ASCVD event?
-
GERALD ASIN1yryes , believer that the lower the LDL the better and use all prooducts available
-
NULL NULL1yrgoals of 70 are strict and have been known to lower risk known therapies are generally good to get that effect to try lower goals is difficult and Show More
