Meeting the Unmet Needs of Patients with Hypercholesterolemia

Saturday, March 19 at 9:35 am

NEW ORLEANS—In Saturday morning’s session, “Meeting the Unmet Needs of Patients with Hypercholesterolemia: A Focus on PCSK9 Inhibitors,” CRS attendees received an overview of various strategies to enhance the treatment and outcomes of patients with hypercholesterolemia.

In their presentation, Ty Gluckman, MD, FACC, medical director of clinical transformation, and Pamela Morris, MD, FACC, FACP, co-director of women’s heart care at the Medical University of South Carolina, discussed a number of objectives, including the integration of the latest clinical data with current guideline recommendations in an effort to optimize hypercholesterolemia, and incorporating PCSK9 inhibitors to improve outcomes in these patients based on individual characteristics and risks. Gluckman and Morris, who is also director of the Seinsheimer Cardiovascular Health Program at MUSC, also outlined the clinical impact of medication non-adherence in patients with hypercholesterolemia, and addressed the implementation of strategies, including patient engagement tools, to optimize LDL-C control and outcomes.

Gluckman, for example, provided a “pragmatic view” of the 2013 ACC/AHA Cholesterol Treatment Guidelines and the use of statin therapy in patients at greater risk of cardiovascular disease (CVD). The guidelines, Gluckman noted, do not recommend LDL-C goals, but expected LDL-C reductions equal or greater to 50%, and 30% to 49% with high- and moderate-intensity statins, respectively.

In addressing the “fine print” of the aforementioned guidelines, the presenters touched on departures from previous guidelines, noting that current clinical trial data “no not indicate what the target should be,” and “we do not know the magnitude of additional atherosclerotic cardiovascular disease (ASCVD) risk reduction that would be achieved with 1 target lower than another.” Noting that future clinical trials could conceivably provide information that warrants reconsidering the “no treat to target” strategy, Gluckman and Morris add that ongoing randomized clinical trials of new LDL-C-lowering drugs, in addition to maximal statin therapy, may address the potential adverse effects of multidrug therapy with an unknown magnitude of ASCVD event reduction.

Ultimately, the initial choice of treatment should be based on ACC/AHA guidelines, and practitioners should consider treating to targets highlighted by NLA recommendations, according to Gluckman and Morris, urging physicians to “individualize [their] approach to dealing with statin ‘intolerance’ and being mindful of issues of adherence with statin therapy.

The presenters also recommended considering a diagnosis of familial hypercholesterolemia in patients with elevated LDL-C and appropriate family history, and think about add-on therapy, including ezetimibe and/or PCSK9 inhibitors, in patients with ASCVD or familial hypercholesterolemia who are not adequately controlled on maximally tolerated statin therapy.

“Remember, guidelines are just that,” they said. “Continue to individualize therapy!”

—Mark McGraw