21812_Managing LDL-C to Reduce Cardiovascular Disease Risk: Defining Best Clinical Practice

In this program, an expert faculty will discuss the evidence and recommendations for managing LDL-C in patients with ASCVD, familial hypercholesterolemia (FH), diabetes, and those at increased cardiovascular risk without ASCVD.

Statin trials have demonstrated atherosclerotic cardiovascular disease (ASCVD) risk reduction
with progressively lower levels of LDL-cholesterol (LDL-C). The 2010 meta-analysis of statin
trials by the Cholesterol Treatment Trialists Collaboration (CTTC) revealed a 22% relative risk
reduction in major vascular events per 39 mg/dL reduction in LDL-C that is consistent across
baseline LDL-C levels, down to less than 77 mg/dL. Nonstatin drugs such as ezetimibe and
PCSK9 inhibitors further lower LDL-C levels and further reduce cardiovascular risk when added
to statins, while demonstrating safety at very low LDL-C levels. A meta-analysis for statins and
nonstatins (Sabatine et al., 2018) has indicated virtually the same magnitude of risk reduction as
demonstrated in the CTTC analysis in which the starting LDL-C was nearly twice as high. In this
recently published analysis, there is a consistent relative risk reduction in major vascular events,
starting as low as a median of 63 mg/dL and achieving levels as low as a median of 21 mg/dL,
with no observed offsetting adverse effects. An abundance of data now provide support for the
concept that for LDL-C lowering in high-risk patients, “lower is better”, and “lowest is best”. In this
program, an expert faculty will discuss the evidence and recommendations for managing LDL-C
in patients with ASCVD, familial hypercholesterolemia (FH), diabetes, and those at increased
cardiovascular risk without ASCVD.

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