Who is at Risk for Atherosclerotic Cardiovascular Disease

Meron Mezgebe, Mercer University College of Pharmacy

Elevated cholesterol increases the risk for developing atherosclerotic cardiovascular disease (ASCVD). [1] For the monitoring of cholesterol levels the American College of Cardiology and American Heart Association (ACC/AHA) recommend an initial lipid panel of patients 21 years or older, with no clinical ASCVD, and not currently on cholesterol-lowering drugs. The ACC/AHA statin benefit group assignment is made using patients’ age, comorbidities, 10-year ASCVD risk, and lipid panel. [2] A systematic review on lipid screening of younger adults (21-39 years) found no studies directly evaluating the effects of lipid screening versus no screening in younger adults. [3] The U.S. preventative services task force (USPSTF) recommends screening for lipid disorders in men 35 years or older and women 45 years or older, unless they have increased risk of coronary heart disease. [4] Continue reading

Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

Sandy Liu, Mercer University College of Pharmacy

A 2016 guideline from the American College of Cardiology stated that the inability to achieve a 30%-50% low-density lipoprotein cholesterol (LDL-C) reduction with statins and/or dietary interventions may necessitate the initiation of the following medications: ezetimibe, bile acid sequestrants and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.  [1]

Evolocumab is a human monoclonal antibody that inhibits proprotein convertase subtilisin/kexin type 9 by binding to low-density lipoprotein receptors on hepatocyte surfaces to promote LDL-receptor degradation within the liver, thereby lowering LDL-C levels. [2]

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Statin Eligibility, Coronary Artery Calcification, and Cardiovascular Events

Elizabeth Lai, Mercer University College of Pharmacy

The National Cholesterol Education Program’s 2004 Updated Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (ATP III) guidelines and 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines have been used to determine statin eligibility over the last decade.  According to a review article, the 2013 ACC/AHA cholesterol guidelines group management of cholesterol by benefit from statin therapy.  It also includes improved risk assessment for the rest of the population by use of a global cardiovascular disease (CVD) risk calculator.1

A review of the 2013 ACC/AHA cholesterol guidelines suggests a new standard for treating cholesterol and focuses on using the appropriate intensity of statin therapy compared to the previous ATP III guideline which recommended treatment based on specific low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein cholesterol (HDL-C) treatment goals.2

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