Erin D. Michos, MD, MHS: Managing Dyslipidemia with Novel Agents


A case for more proactive lipid-lowering treatment initiation in a high-risk population.

In a new presentation at the The Metabolic Institute of America (TMIOA) 2021 World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC) meeting in Los Angeles this week, Erin D. Michos, MD, MHS, highlighted the lacking general response to increased lipid levels in patients at risk of atherosclerotic cardiovascular disease (ASCVD).

Michos, the Associate Director of Preventive Cardiology at Johns Hopkins University, explained that many at-risk patients are currently not a guideline-set LDL-C thresholds; such guidelines also recommend these patients are considered for combination lipid-lowering therapy with statins.

It’s Michos’ recommendation that combination therapy is considering even earlier in the risk-developing stages.

“First of all, I emphasize that LDL cholesterol is causally related to atherosclerotic cardiovascular disease risk, which is why it’s a central target for both prevention and management for ASCVD,” she explained. “Lower accumulation of LDL delays the onset of CVD events—it slows plaque progression. So you want to be lower and longer, and you also want to get there faster as well.”

Michos also stressed that single-pill combination therapy may have better adherence among high-risk patients, which could harbor more long-term risk reduction success.

She added in her presentation that recent data suggest many high-risk patients in both European countries and the US are generally reaching lipid thresholds while also taking statins without lipid-lowering therapy.

“Really, I was trying to make the plea that we need to be a lot more aggressive, being intensive up front, start high-intensity statins on the onset, and consider initial use of combination therapy if the LDL is more than 50% above one’s goal,” Michos said.

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