MONDAY, Aug. 29, 2022 (HealthDay News) — Several new nonstatin agents have low-density lipoprotein cholesterol-lowering efficacy and can be considered for patients at risk for atherosclerotic cardiovascular disease (ASCVD), according to an expert consensus decision pathway published online Aug. 25 in the Journal of the American College of Cardiology.

Donald M. Lloyd-Jones, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues provide practical guidance for clinicians and patients in situations not covered by the 2018 American Heart Association/American College of Cardiology/multisociety cholesterol guideline.

The authors offer algorithms that assume that all patients are in one of four evidence-based management groups: adults aged 20 years or older with clinical ASCVD on statin therapy for secondary prevention; adults with primary severe hypercholesterolemia; and those with and without diabetes receiving statins for primary prevention of ASCVD. Factors that should be considered in terms of management include adherence to lifestyle modifications and evidence-based, guideline-recommended statin treatment; risk-enhancing factors; control of risk factors; the potential benefits and potential harms; and patient reference with respect to the addition of nonstatin therapies. Optional interventions that can be considered include referral to a lipid specialist and registered dietician, ezetimibe, bile acid sequestrants, proprotein convertase subtilisin/kexin type 9 monoclonal antibodies, bempedoic acid, and inclisiran.

“Recommendations attempt to provide practical guidance for clinicians and patients regarding the use of nonstatin therapies to further reduce ASCVD risk in situations not covered by the guideline until such time as the scientific evidence base expands,” the authors write.

Several authors and reviewers disclosed financial ties to the pharmaceutical industry.

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