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With September recognized as National Cholesterol Education Month, Dr. Weiss reflects on the importance of cholesterol management as part of mitigating risk of events in patients with ASCVD.
The enormous importance of cholesterol management for reduction and prevention of atherosclerotic cardiovascular disease (ASCVD) cannot be overstated.
While ample evidence exists that reductions in low-density lipoprotein cholesterol (LDL-C) reduce the risk of cardiovascular events and death in patients with ASCVD, data gathered by the American College of Cardiology (ACC) from the PINNACLE registry reveal that 21.1% of these patients had no history of lipid-lowering therapy use and 84.5% did not meet LDL-C goal of less than 70mg/dL.1
Patients with ASCVD least likely to achieve LDL-C goals while on a statin include younger patients, African Americans, and hypertensive patients.1 These facts underscore the importance of determining and overcoming barriers to achieving optimal cholesterol management.
Timothy Attebery, DSc, MBA, FACHE, Chief Executive Officer of the American College of Cardiologists states, “Management of lipid disorders has become more complex as new data, drugs and clinical standards around lipid management are introduced. The College has many successful tools and initiatives that have helped our members provide the most advanced and effective lipid management strategies for their patients, but there is more work to be done.”2
In 2019, the American College of Cardiology in cooperation with the American Heart Association (AHA) issued updated guidelines, made simple, for management of blood cholesterol. In these guidelines they highlight ten take-home messages to reduce the risk of ASCVD through cholesterol management.3
These guidelines are concise and should be easily attainable with the tools we possess. However, being armed with a primer for good care clearly is not enough. The American College of Cardiology in conjunction with Sanofi and Regeneron Pharmaceuticals Inc. have developed an initiative called the TRANSFORM LDL-C trial aimed at addressing the gaps in treatment for ASCVD patients with regards to cholesterol-lowering therapy.
Dharam Kumbhani, MD, SM, FACC is a senior author of the TRANSFORM LDL-C trial. Dr. Kumbhani states, “Large groups of patients with ASCVD are not achieving low enough LDL-C levels, which puts them at greater risk of recurrent cardiovascular events and death.”1
The TRANSFORM LDL-C initiative aims to optimize patients’ access to the latest evidence-based treatments for LDL-C lowering and cardiovascular event risk reduction based on the ACC/AHA guidelines.1 Dr. Kumbhani goes on to say, “It’s apparent that large gaps exist and that more efforts are needed in implementing the cholesterol guidelines. Next steps are examining what barriers exist in achieving these treatment goals and how to address these barriers.” These barriers, once identified, will need to be addressed if the gaps in treatment, access, and goal achievement are to be eliminated.
In general, before the results of the TRANSFORM LDL-C initiative are known, things can be done to reduce barriers to achieving the recommended LDL-C targets in patients with ASCVD. Simplifying treatment regimens can increase adherence especially in patients with several comorbidities such as hypertension and hyperlipidemia. Prescribing single-pill combinations containing treatment for both conditions makes it more likely the patient will comply with their regimen.4
Further, initiating treatment early with regular follow up and positive reinforcement from clinicians at each office visit are a good first step toward reducing cardiovascular risk in patients with hyperlipidemia. Together we can take the evidence and guidelines at our disposal and eliminate barriers to achieving the results our patients deserve improving outcomes and the quality of their lives.