Kausik Ray, MD: A Risk-Based Look at LDL Cholesterol Lowering


Dr. Ray discusses the impact of current practice on cholesterol goal attainment and what more needs to be done.

In an interview with HCPLive, Kausik Ray, MD, Imperial College London, provided perspective on his recent presentation on the limits of low-density lipoprotein cholesterol (LDL-C) lowering on cardiovascular outcomes.

The presentaiton was given at the 6th Annual Heart in Diabetes Meeting in Philadelphia, Pennsylvania.

Ray focused on contemporary data on LDL-C lowering in clinical practice, as well as the larger impact of current practice on cholesterol goal attainment.

"The key concept about this was its risk based," Ray said. "So, people at greatest risk, we try and have cholesterol levels that match the level of risk."

He noted there is not a way to reach those levels in 100% of patients without utilizing combination therapy, calling it the mantra. Ray additionally said that clinicians may need to use lower goals and combination therapy in a signifcant amount of patients.

"We're going to have to use combination therapy in about 80% of our patients, of whom at least a half will need three drugs or two drugs and an injectable therapy, for example," he said. "That's the big takeaway, but we're still not implementing any of this properly."

Ray went on to discuss emerging therapies and barriers for patients. Due to the asymptomatic nature of patients, it may be difficult to determine whether or not to aim for a lower level or not, Ray said.

"The question is, do I go further? Do I go down a little bit lower, and you think, well, maybe I'll just watch and wait, but watch and wait might be in another event in somebody. That's one of the barriers."

He additionally discussed cost related barriers of newer injectable therapies and the need for better utilization of the agents themselves in practice.

"I think one of the biggest issues that we have in healthcare systems and their redesigns is needed, because we focus far too much and we reimburse things like procedures which treat disease," Ray said. "What we should be focusing on a healthcare systems that incentivize preserving health, so when you think about prevention as an investment, not as a cost data."

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