Evolving Strategies for Cholesterol Management and Atherosclerotic Cardiovascular Disease Risk Reduction - Episode 18

Key Takeaways for Lipid Lowering in Hypercholesterolemia and ASCVD

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Drs Erin Michos, Pam Taub, Robert Busch, Alison Bailey, and Jorge Plutzky offer key takeaways in the management of hypercholesterolemia and ASCVD.

Erin D. Michos, MD, MHS, FACC, FASPC: In our last few minutes, we’re going to go around the table. What’s 1 key takeaway point that you want to drill home to our audience? I’d like to have everyone get a chance to give their takeaway. I’ll start with Pam. What’s the message you want to emphasize?

Pam Taub, MD, FACC, FASPC: My takeaway is to look for subclinical atherosclerosis. That’s where we can make a huge impact. Once somebody has had a heart attack or a stroke, the cat’s out of the bag. We know what we have to do. We know we have to be aggressive. But look for subclinical atherosclerosis, whether it’s through coronary calcium scoring or other biomarkers, and treat those patients aggressively.

Erin D. Michos, MD, MHS, FACC, FASPC: Jorge,what’s your key takeaway?

Jorge Plutzky, MD: My point is around LDL [low-density lipoprotein] lowering and achieving that we know that what the drugs do and the LDL lowering they achieve. As caregivers, we have to be committed to getting patients to appropriate LDL levels because it will change outcomes. Creating the rationale, explaining the rationale, and educating around that is essential. We use the tools we have to achieve those LDLs. It’s important to do it. We just have to be fully committed to it.

Erin D. Michos, MD, MHS, FACC, FASPC: Robert, what’s your takeaway?

Robert Busch, MD: Use the tools. We have terrific tools. If you started out with nothing 20 or 30 years ago, look what we have to prevent heart disease. We have a potpourri of drugs, whether it’s for blood pressure, lipids, or diabetes, to help the patient. Looking at the patient with type 2 diabetes, think of that patient as a heart attack waiting to happen. I heard a very wise cardiologist say, “Having an event is 1 bad day.” In primary prevention and secondary prevention, for patients who have high cardiac calcium scores, it’s a bad day that they had the event. Treat them as someone who had an event. Be aggressive with that patient. Outline to them that you want to prevent the first event.

Alison Bailey, MD, FACC: I have 2 takeaways. When we see patients struggling with lipids, sometimes we don’t take as much time on top to talk about lifestyle. It’s important to reiterate the importance of exercise and healthy diet in every visit with every patient. My second takeaway is that it’s also important to use all the medicine we have in our armamentarium to get to an LDL of less than 55 mg/dL to address diabetes. To address weight, we have many options that help patients lose weight. That’s key with addressing lipids: addressing every risk factor that we can think of.

Erin D. Michos, MD, MHS, FACC, FASPC: My takeaway is that I like thinking about LDL years and minimizing the total duration of exposure to these atherogenic particles. We need to lower LDL for longer and get there faster. We need to think about combination therapy up front earlier because these patients are very high risk. We need to intensify therapy every 4 to 12 weeks to overcome some of this inertia.

Thank you all for this rich and informative discussion. Thank you for watching this Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peer Exchanges and other great content right in your in-box.

Transcript edited for clarity