Groundbreaking Guidelines Unveiled for LDL-C Reduction

A new category of cardiovascular “extreme risk” has LDL-C goals of

Two leading experts in dyslipidemia helped the American Association of Clinical Endocrinologists’ (AACE) 26th Annual Scientific and Clinical Congress open with a strong first day of sessions by reporting on the results of recently introduced clinical guidelines for more aggressive treatment in reducing low-density lipoprotein cholesterol (LDL-C) in patients meeting certain criteria.

The new guidelines are the first to recommend more intense treatment and intervention in patients with progressive atherosclerotic cardiovascular disease (ASCVD) including unstable angina after achieving an LDL-C <70 mg/dL; patients with established ASCVD and diabetes; patients with stage 3 or stage 4 chronic kidney disease; patients with heterozygous familial hypercholesterolemia (HeFH); and male and female patients younger than 55 and 65 years of age, respectively, with a history of premature cardiovascular disease. Patients with these conditions now fall into a newly introduced category of cardiovascular “extreme risk,” with treatment goals now to include LDL-C <55 mg/dL, non—high-density lipoprotein cholesterol <80 mg/dL, and apolipoprotein B <70 mg/dL.

Presenters Dr. Paul Jellinger, professor of clinical medicine at the University of Miami, and Dr. Yehuda Handelsman, medical director and principal investigator at the Metabolic Institute of America and chair of the AACE Diabetes Scientific Committee, used case-based evidence in their “Meet the Experts” workshop to underscore the application of the more aggressive treatment for the LDL-C reduction to <70 in patients with progressive ASCVD. Their presentation also highlighted the value of the coronary artery calcium (CAC) score and inflammatory markers to stratify risk in these patient populations.

According to the presenters, these groundbreaking guidelines provide a value assessment of adding ezetimibe and PCSK9 inhibitors to the treatment plans of patients with cardiovascular disease who are unable to reach LDL-C goals with statin therapy alone. In addition to lowering LDL-C goals to well below previously recommended levels, the 87 evidence-based recommendations made in the report gives special consideration to women and pediatric patients with dyslipidemia.

“While suggestive evidence pointed in the direction of better outcomes with more aggressive LDL treatment, the IMPROVE-IT trial was the first prospective demonstrated clearly that driving LDL down to 53 provided a clear, significant benefit in reducing cardiovascular outcomes in high-risk groups,” Dr. Jellinger said in a news release circulated immediately prior to the conference. “By expanding the group of patients studied in IMPROVE-IT to other very high-risk situations, our knowledge base expanded considerably, leading to the creation of the new risk category, a broader range of disease stages, and the accompanying groundbreaking treatment and intervention recommendations.”

Their complete report, “American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease—Executive Summary,” was published in the April 2017 issue of Endocrine Practice.

The AACE 26th Annual Scientific and Clinical Congress is being held in Austin, Texas, May 3-7, 2017.

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