How Do We Get There from Here: Partnering with Patients to Achieve LDL Goals
Mar 8, 2023
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Drs. Marc Bonaca, Pam Taub, and Heather Johnson talk about multiagent therapy for cholesterol treatment and the efficacy of novel agents. They emphasize the importance of shared decision-making, managing high-risk populations, and simplifying prior authorization. They also discuss the benefits of a team approach in lipid management and the potential of non-statin options like Bempedoic acid.
Combination therapy, including alternative options like Bempedoic acid, is crucial for achieving target LDL levels and improving outcomes in high-risk patients.
Bempedoic acid offers a safe and effective non-statin option for lowering LDL cholesterol with minimal risk of diabetes, especially for patients unable to tolerate statins.
Deep dives
Importance of Aggressively Modifying LDL Cholesterol in Clinical Practice
In the podcast, Dr. Pam Togham highlights the significance of lowering LDL cholesterol and the need for aggressive risk modification. Despite the availability of multiple therapies, clinical practice often falls short in achieving target LDL levels recommended by guidelines. Statin monotherapy, the traditional approach, is no longer sufficient. Dr. Togham emphasizes the importance of combination therapy and alternative options like Bempedoic acid for patients unable to tolerate statins. The breakthrough study of clear outcomes demonstrates the efficacy of Bempedoic acid in reducing mace events, LDL cholesterol, and high sensitive CRP levels. This study provides an effective non-statin option for high-risk patients.
Benefits and Considerations of Bempedoic Acid in Cardiovascular Disease Management
Dr. Heather Johnson discusses the exciting features of Bempedoic acid highlighted in the clear outcomes trial. Bempedoic acid is a liver-specific prodrug that works through a similar pathway as statins without significant skeletal muscle involvement. The trial, which included a significant number of women, demonstrates a 21% reduction in LDL cholesterol, a 22% reduction in high sensitive CRP, and a 13% decrease in mace events. Bempedoic acid is a safe option with minimal risk of diabetes and potential glycemic benefits. However, caution is advised in patients with gout due to elevated uric acid levels. With its inclusion in ACC expert pathways, Bempedoic acid offers a promising addition to the lipid-lowering toolbox.
Implementing Combination Therapy and Overcoming Barriers in Clinical Practice
To optimize lipid therapy, a shift in paradigm is necessary, as discussed by Dr. Togham. Monotherapy is no longer sufficient, and combination therapy should be considered from the outset, especially for high-risk patients. The goal is to quickly institute multiple agents for patients with LDL levels in the 200s or those at a high risk of recurrent events. Combination therapies, such as statins with a zetamibe, Bempedoic acid, or PCSK9 inhibitors, can achieve substantial LDL reductions, even at low statin doses. Overcoming barriers, such as prior authorizations, requires a systemic approach and proper documentation. The emphasis is on shared decision-making, patient education, close follow-up, and multidisciplinary teamwork to enhance patient outcomes.
In this episode of Cholesterol Conversations, Drs. Marc Bonaca, Pam Taub, and Heather Johnson discuss how multiagent therapy can improve the provision of care in the real world. Covered topics include new data from the 2023 ACC Scientific Sessions on the efficacy of novel agents and the role of combination therapy, as well as the importance of shared decision-making and keys to managing high-risk populations.
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