Heart Groups Issue Guidelines on Non-Statin Therapies for LDL-Lowering

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

The American College of Cardiology and American Heart Association have issued new guidance on initiating non-statin therapy to lower LDL cholesterol in patients who are currently using, or have attempted to use, statins.

The document offers algorithms for adjunctive non-statin therapy in the four distinct patient groups identified in the ACC/AHA 2013 lipid guidelines:

• Patients with clinical atherosclerotic cardiovascular disease

• Those with LDL levels at or above 190 mg/dL not caused by secondary conditions (e.g., hypothyroidism)

• Patients aged 40–75 with diabetes and LDL levels between 70 and 189 mg/dL

• Those aged 40–75 without diabetes but with LDL levels between 70 and 189 mg/dL and with predicted 10-year risk for atherosclerotic cardiovascular disease of 7.5% or higher

For most higher-risk patients, the new guidelines recommend considering ezetimibe (10 mg) as the first non-statin therapy. Recommendations on incorporating the PCSK9 inhibitors evolocumab and alirocumab, approved in 2015, are also offered.

The guidelines were published in the Journal of the American College of Cardiology and presented over the weekend at the ACC's annual meeting in Chicago.