Therapeutic Persistence in the Management of Familial Hypercholesterolemia: A Case of Acquired PCSK9 Inhibitor Nonresponse.

Familial hypercholesterolemia (FH) is an inherited disorder of lipid metabolism that causes marked elevations in low-density lipoprotein cholesterol and is associated with premature atherosclerotic cardiovascular disease. A 71-year-old woman with FH, established atherosclerotic cardiovascular disease, and statin intolerance presents to the cardiology clinic to discuss lipid management. Despite having failed combinations of statins, ezetimibe, and 2 proprotein convertase subtilisin/kexin type 9 inhibitors that use monoclonal antibodies, she was able to achieve low-risk low-density lipoprotein cholesterol levels using a novel way to lower proprotein convertase subtilisin/kexin type 9 levels with inclisiran.

Top 10 Tips for Using Statins in Clinical Practice.

Statins are the mainstay of cholesterol treatment to prevent atherosclerotic cardiovascular disease. However, significant barriers, including physician and patient factors, prevent the optimal use of this drug class. In this article, we provide 10 clear and simple tips for clinicians when prescribing statins.

Statin-Associated Muscle Symptoms Among New Statin Users Randomly Assigned to Vitamin D or Placebo.

Importance: Statin-associated muscle symptoms (SAMS) are common and may lead to discontinuation of indicated statin therapy. Observational studies suggest that vitamin D therapy is associated with reduced statin intolerance, but no randomized studies have been reported.

Objective: To test whether vitamin D supplementation was associated with prevention of SAMS and a reduction of statin discontinuation.

Guidelines for the management of hyperlipidemia: How can clinicians effectively implement them?

Guidelines support lowering cholesterol to decrease atherosclerotic cardiovascular disease (ASCVD) risk across the entire lifespan with intensive lifestyle intervention, as well as statin and non-statin pharmacotherapy for those at highest risk. Modest improvements in the initiation, use, and adherence to statin therapy in patients with ASCVD have occurred over the past decades. However, studies continue to document a less than desired implementation of guidelines highlighting a substantial and persistent treatment gap.

Comparing eligibility for statin therapy for primary prevention under 2022 USPSTF recommendations and the 2018 AHA/ACC/ multi-society guideline recommendations: From National Health and Nutrition Examination Survey.

Introduction: The United States Preventive Services Taskforce (USPSTF) recently released recommendations for statin therapy eligibility for the primary prevention of cardiovascular disease (CVD). We report the proportion and the absolute number of US adults who would be eligible for statin therapy under these recommendations and compare them with the previously published 2018 American Heart Association (AHA)/ American College of Cardiology (ACC)/ Multisociety (MS) Cholesterol guidelines.

Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 of adults aged 40-75 years without prevalent self-reported atherosclerotic CVD (ASCVD) and low-density lipoprotein-cholesterol <190 mg/dL.

Inter-Individual Variability in Lipid Response: A Narrative Review.

Lipid-lowering guidelines emphasize shared decision-making between clinicians and patients, resulting in patients anticipating the degree of response from diet or drug therapy. Challenging for physicians is understanding the sources of variability complicating their management decisions, which include non-adherence, genetic considerations, additional lipid parameters including lipoprotein (a) levels, and rare systemic responses limiting benefits that result in non-responsiveness to monoclonal antibody injection. In this narrative review, we focus on the variability of low-density lipoprotein cholesterol (LDL-C) response to guideline-directed interventions such as statins, ezetimibe, bile acid sequestrants, fibrates, proprotein/convertase subtilisin-kexin type 9 inhibitors, and LDL-C-lowering diets.

Statin-associated muscle symptoms in the VITamin D and OmegA-3 TriaL (VITAL).

Statins are highly effective medications that reduce risk of atherosclerotic cardiovascular disease, but are very commonly discontinued by patients because of muscle symptoms. The risk factors for statin-associated muscle symptoms (SAMS) are not well understood, so in this study we examined the predictors of SAMS in a well-studied cohort of patients in the VITAL trial. We found that female sex and younger age (50-64 years) were significant, independent predictors of higher rates of SAMS.

Managing Atherosclerotic Cardiovascular Risk in Young Adults: JACC State-of-the-Art Review.

There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in the 20- to 39-year age range (young adults). These include tobacco use, elevated blood pressure/hypertension, family history of premature ASCVD, primary severe hypercholesterolemia such as familial hypercholesterolemia, diabetes with diabetes-specific risk-enhancing factors, or the presence of multiple other risk-enhancing factors, including in females, a history of pre-eclampsia or menopause under age 40.

Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006-2015.

Importance: Shared decision-making (SDM), one of the pillars of patient centered care is strongly encouraged and has been incorporated into the management of atherosclerotic cardiovascular disease (ASCVD) but the expansion of its use has been limited.

Objective: To determine the association of SDM on patient-reported health status, measures of quality of care, healthcare resource utilization, and healthcare spending among US adults with ASCVD.

Method: This is a retrospective cohort study in an ambulatory setting, utilizing the Medical Expenditure Panel Survey (MEPS) 2006-2015.

Eruptive Xanthomas: Importance of Recognition to Reduce Delay of Effective Triglyceride Reduction.

Eruptive xanthomas are localized lipid deposits in the dermis and an important early clue to severe hypertriglyceridemia. These small erythematous or yellow papules that localize to the extensor surfaces of extremities, buttocks, and the back are often overlooked during routine visits secondary to poor familiarity and limited skin examinations. We present 3 cases of patients with eruptive xanthomas and severe hypertriglyceridemia who underwent skin biopsy and waited weeks to years before receiving effective treatment.

Coronary artery calcium scoring in patients with statin associated muscle symptoms: Prescribing statins for those most likely to benefit.

For primary prevention, statin therapy reduces the incidence of atherosclerotic cardiovascular disease (ASCVD) events in adults with intermediate or high estimated 10-year risk using traditional population-based risk calculators. While a variety of reported symptoms may limit statin adherence, muscle complaints, whether typical or atypical of that associated with statin therapy, are the most common reported by patients. Because additional testing, alteration in the patient's medical regimen and subsequent medical visits are often required, an informed clinician-patient discussion and shared decision making are necessary to achieve the best outcomes.

Association of patient, provider and facility related characteristics with statin associated side effects and statin use: Insight from the Veteran's Affairs healthcare system.

Background: Statin associated side effects (SASE) are a leading cause of statin discontinuation.

Objective: We evaluated patient, provider, and facility characteristics associated with SASEs and whether these characteristics impact statin utilization.

Methods: Patients with atherosclerotic cardiovascular disease (ASCVD) receiving care across the Veterans Affairs healthcare system from October 1, 2014 to September 30, 2015 were included.

High-Intensity Statins Benefit High-Risk Patients: Why and How to Do Better.

Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater.