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Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management

Mancini, G.B.John et al.

Atherosclerosis. Volume 263 (2017); pp 112-118 -- Elsevier Ireland Ltd

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  • Title:
    Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management
  • Author: Mancini, G.B.John;
    Gupta, Milan;
    Tsigoulis, Michelle;
    Cannon, Christopher P.;
    Genest, Jacques;
    Ray, Kausik K.;
    Santos, Raul D.;
    Watts, Gerald F.;
    Raggi, Paolo
  • Found In: Atherosclerosis. Volume 263 (2017); pp 112-118
  • Journal Title: Atherosclerosis
  • Subjects: Arteriosclerosis--Periodicals; Atherosclerotic cardiovascular disease--Angina pectoris--Cardiovascular risk--Low density lipoprotein-cholesterol--Proprotein convertase subtilisin/kexin type 9 inhibitors--Primary prevention; Electronic journals; Dewey: 616.136
  • Rights: legaldeposit
  • Publication Details: Elsevier Ireland Ltd
  • Abstract: Abstract: Background and aims:

    Overt atherosclerotic cardiovascular disease (ASCVD) warrants aggressive lipid lowering. Imaging for ambiguous symptoms suggesting ischemia or for clarification of CV risk in asymptomatic individuals often uncovers previously unknown ASCVD. Guidelines do not provide clear recommendations for aggressive lipid lowering in such cases. We explored physicians' perception, as influenced by tests that detect ASCVD, regarding appropriateness of getting to lipid goals and for theoretically accessing proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i).

    Methods:

    A questionnaire was developed including cases of low to high CV risk, chronic kidney disease (CKD) or type 2 diabetes mellitus (T2DM). Each case was considered with or without angina symptoms and, in turn, whether testing identified previously unknown advanced, early/subclinical or no ASCVD. Synthesis of responses was facilitated by using a scale for perceived appropriateness from 1 (lowest) to 9 (highest).

    Results:

    Getting to goal and, if not achieved by statins and/or ezetimibe, accessing PCSK9i was considered appropriate in patients with T2DM with preclinical or advanced ASCVD, patients with moderate or high CV risk and advanced ASCVD, patients with CKD or low CV risk with angina symptoms and advanced ASCVD. For most of the remaining cases adding PCSK9i was considered only possibly appropriate.

    Conclusions:

    Physicians' perception of appropriateness for achieving lipid goals, including access to PCSK9i, is markedly influenced by detection of previously unknown ASCVD. Since these commonly encountered scenarios do not clearly meet current indications for PCSK9i, our data identify pressing areas requiring further research.

    Highlights:

    The term ASCVD has broad connotations.

    Physicians often uncover ASCVD during risk stratification or assessment of patient symptoms.

    Whether or not such findings should impact the aggressiveness of lipid lowering in primary prevention is unclear.

    Results suggest that newly discovered ASCVD strongly influences perceived appropriateness for aggressive lipid lowering.


  • Identifier: System Number: LDEAvdc_100048173029.0x000001; Journal ISSN: 0021-9150; 10.1016/j.atherosclerosis.2017.06.006
  • Publication Date: 2017
  • Physical Description: Electronic
  • Shelfmark(s): ELD Digital store

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