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Reviews in Cardiovascular Medicine  2018, Vol. 19 Issue (S1): 1-8     DOI: 10.3909/ricm19S1S0004
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Identifying Patients for Nonstatin Therapy
Jennifer G. Robinson1, Karol E. Watson2
1 Departments of Epidemiology & Medicine, University of Iowa College of Public Health and Carver College of Medicine, Iowa City, IA
2 Departments of Medicine & Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA
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Statins are first-line therapy for reducing atherosclerotic cardiovascular disease (ASCVD) risk. Some patients remain at high ASCVD risk despite maximizing statin therapy. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies (mAbs) have been shown to reduce ASCVD events in randomized trials and may be of benefit in selected high-risk patients with cardiovascular disease (CVD) or familial hypercholesterolemia (FH). Number-needed-to-treat (NNT) to prevent one ASCVD event can help identify groups of patients who may gain a net benefit from added nonstatin therapy. Patient groups with NNTs <25 (in whom PCSK9 mAbs may approach cost effectiveness with discounting) include extremely high-risk patients (those with CVD with FH, polyvascular disease, or recurrent ASCVD events) with lowdensity lipoprotein cholesterol (LDL-C) levels ≥70 mg/dL, very high-risk patients (those with CVD with diabetes [and no polyvascular disease], chronic kidney disease, or acute coronary syndromes, or CVD or FH with poorly controlled risk factors) with LDL-C levels ≥100 mg/dL, and high-risk patients (those with CVD or FH with well-controlled risk factors) with LDL-C ≥130 mg/dL. Ezetimibe, which is generic in the United States, is reasonable for patient groups with NNTs <30, the level considered reasonable by most patients. This includes extremely high-risk patients with LDL-C levels ≥130 mg/dL, or very high-risk patients with LDL-C ≥190 mg/dL. All guidelines recommend statin therapy for the prevention of ASCVD.

Key words:  Atherosclerotic cardiovascular disease      PCSK9 monoclonal antibodies      Nonstatin therapy      Cholesterol-lowering therapies     
Published:  20 January 2018     

Cite this article: 

Jennifer G. Robinson, Karol E. Watson. Identifying Patients for Nonstatin Therapy. Reviews in Cardiovascular Medicine, 2018, 19(S1): 1-8.

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