Abstract
This viewpoint describes the results of a survey administered to 55 physicians who
are key opinion leader experts in dyslipidemia management and thoroughly knowledgeable
about current guidelines and emerging therapies. The purpose was to determine the
level of low density lipoprotein-cholesterol (LDL-C) achieved with maximally tolerated
statin monotherapy that would trigger a preference by most for use of the soon to
be available proprotein convertase subtilisin/kexin type 9 inhibitor as the next add-on
agent. Because current guidelines suggest a uniform LDL-C goal when treating patients
meeting guideline indications for therapy, it was expected that the size of the gap
between LDL-C goal and LDL-C attained with maximally tolerated statins would uniformly
dictate when proprotein convertase subtilisin/kexin type 9 inhibitors would be desired.
This expectation, however, was not met. In particular, the results suggest that primary
prevention patients and patients with chronic kidney disease do not appear to represent
high priority circumstances for achieving even the current LDL-C goal despite existing
guidelines. Implications for future guidelines in the post-statin era are discussed.
Résumé
Cette publication indique les résultats d’un sondage effectué auprès de 55 médecins
chefs de file en matière de prise en charge de la dyslipidémie et donc entièrement
au fait des lignes directrices en vigueur de même que des nouveaux traitements à venir.
Ce sondage avait pour but de déterminer à partir de quel taux de cholestérol à lipoprotéines
de faible densité (C-LDL), obtenu à l’aide des doses maximales tolérées de statines
en monothérapie, la plupart des médecins seraient enclins à choisir d’ajouter le nouveau
traitement d’appoint par l’inhibiteur de la proprotéine convertase subtilisine/kexine
de type 9 (PCSK9) qui sera bientôt disponible. Puisque les lignes directrices actuelles
recommandent l’atteinte d’une valeur cible de C-LDL uniforme pour le traitement de
patients, il était attendu que l’écart entre la valeur cible indiquée dans les lignes
directrices et le taux réel de C-LDL obtenu avec des doses maximales tolérées de statines
dicterait clairement le moment où il serait souhaitable d’ajouter le traitement d’appoint
par l’inhibiteur de la PCSK9. Ce n’est toutefois pas ce qui s’est produit. Les résultats
du sondage indiquent notamment que les médecins ne considèrent pas l’atteinte de la
valeur cible de C-LDL comme étant prioritaire chez les patients traités en prévention
primaire et chez ceux atteints de néphropathie chronique, même si elle est préconisée
dans les lignes directrices. Ces questions et leur incidence sur les futures lignes
directrices « post-statines » sont abordées ici.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pravastatin limitation of atherosclerosis in the coronary arteries (PLAC I): reduction in atherosclerosis progression and clinical events. PLAC I investigation.J Am Coll Cardiol. 1995; 26: 1133-1139
- The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial.Lancet. 2011; 377: 2181-2192
- Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015; 372: 2387-2397
- 2012 Update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia for the prevention of cardiovascular disease in the adult.Can J Cardiol. 2013; 29: 151-167
- Effects of proprotein convertase subtilisin/kexin type 9 antibodies in adults with hypercholesterolemia: a systematic review and meta-analysis.Ann Intern Med. 2015; 163: 40-51
- Are PCSK9 inhibitors the next breakthrough in the cardiovascular field?.J Am Coll Cardiol. 2015; 65: 2638-2651
- Efficacy and safety of longer-term administration of evolocumab (AMG 145) in patients with hypercholesterolemia 52-week results from the Open-Label Study of Long-Term Evaluation Against LDL-C (OSLER) randomized trial.Circulation. 2014; 129: 234-243
- Efficacy and safety of evolocumab in reducing lipids and cardiovascular events.N Engl J Med. 2015; 372: 1500-1509
- Efficacy and safety of alirocumab in reducing lipids and cardiovascular events.N Engl J Med. 2015; 372: 1489-1499
- Are the ACC/AHA guidelines on the treatment of blood cholesterol a game changer? A perspective from the Canadian Cardiovascular Society Dyslipidemia Panel.Can J Cardiol. 2014; 30: 377-380
- 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: S1-S45
Article info
Publication history
Published online: July 11, 2015
Accepted:
July 7,
2015
Received:
June 17,
2015
Footnotes
See page 274 for disclosure information.
Identification
Copyright
© 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
