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Help your patients get to their guideline-recommended LDL-C goal to help reduce ASCVD risk1
The American College of Cardiology (ACC) released an Expert Consensus Decision Pathway (ECDP) in 2022 that outlined their Low-Density Lipoprotein Cholesterol (LDL-C) thresholds for patients at risk for Atherosclerotic Cardiovascular Disease (ASCVD).
The 2022 ACC ECDP recommends specific LDL-C goals for certain populations at higher risk of an ASCVD event1a:
a2022 ACC Expert Consensus Decision Pathway defines LDL-C goals as <55 mg/dL, <70 mg/dL, and <100 mg/dL depending on patient risk level.1
bIn addition to the specified LDL-C goal, ≥50% LDL-C reduction is also recommended1
cIn addition to the specified LDL-C goal, ≥ 30-49% LDL-C reduction is also recommended1
dPatients with diabetes and 10-year risk < 7.5% and no additional high-risk factors1
ePatients with high risk for ASCVD include individuals who have a ≥20% 10-year estimated ASCVD risk. Patients at intermediate risk for ASCVD include individuals who have a 10-year estimated ASCVD risk of ≥7.5% to <20%. Patients with borderline risk for ASCVD include individuals who have a 10-year estimated ASCVD risk of 5% to <7.5%.1
fRisk enhancers include: Family history of premature ASCVD (men <55 years, women <65 years), primary hypercholesterolemia (LDL-C 160-189 mg/dL), metabolic syndrome, chronic kidney disease (eGFR 15-59 mL/min/1.73 m2 with or without albuminuria, not treated with dialysis or kidney transplant), chronic inflammatory conditions, history of premature menopause (before 40 years) and history of pregnancy-associated conditions that later raise ASCVD risk, high-risk races/ethnicities, and lipids/biomarkers associated with increased ASCVD risk.1
gVery high risk includes a history of multiple major ASCVD events (recent acute coronary syndrome [ACS] [within the past 12 months], history of myocardial infarction [other than recent ACS], history of ischemic stroke, symptomatic peripheral artery disease) or 1 major ASCVD event and multiple high-risk conditions (Age ≥65 years, heterozygous familial hypercholesterolemia, history of prior coronary artery bypass surgery or percutaneous coronary intervention outside of the major ASCVD event(s), diabetes, hypertension, chronic kidney disease (eGFR 15-59 mL/min/1.73 m2), current smoking, persistently elevated LDL-C ≥100 mg/dL despite conventional management, history of congestive heart failure).1
Many patients with ASCVD are not achieving the 2022 ACC ECDP recommended goals, according to 2019 extrapolation analysis1,4h
hBased on an extrapolation analysis with descriptive statistics of 2019 data from the Truven MarketScan Research Database, extrapolating a population of 24,005,959 patients with ASCVD. Data from the Truven MarketScan Research Database is a large and representative database consisting of US administrative health records from commercial and Medicare supplemental health plans. Enrollees had 1 valid LDL-C measurement in 2019, were diagnosed with ASCVD, and were at least 21 years of age. Patients with likely heterozygous familial hypercholesterolemia were excluded. Patient numbers were extrapolated to approximate national figures using national demographic and ASCVD prevalence numbers.4
Learn more about the cumulative risk of ASCVD when LDL-C remains above goal2
ACC ECDP=American College of Cardiology Expert Consensus Decision Pathway; ACS=acute coronary syndrome; ASCVD=atherosclerotic cardiovascular disease; CKD=chronic kidney disease; CVD=cardiovascular disease; eGFR=estimated glomerular filtration rate; HF=heart failure; LDL-C=low-density lipoprotein cholesterol; MI=myocardial infarction.
References: 1. Writing Committee; Lloyd-Jones DM, Morris PB, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(14):1366-1418. doi:10.1016/j.jacc.2022.07.006 2. Domanski MJ, Tian X, Wu CO, et al. Time Course of LDL Cholesterol Exposure and Cardiovascular Disease Event Risk. J Am Coll Cardiol. 2020;76(13):1507-1516. doi:10.1016/j.jacc.2020.07.059 3. Ference BA, Braunwald E, Catapano AL. The LDL Cumulative Exposure Hypothesis: Evidence and Practical Applications. Nat Rev Cardiol. 2024;21(10):701-716. doi:10.1038/s41569-024-01039-5 4. Gu J, Sanchez R, Chauhan A, et al. Lipid Treatment Status and Goal Attainment Among Patients With Atherosclerotic Cardiovascular Disease in the United States: A 2019 Update. Am J Prev Cardiol. 2022;10:100336. doi:10.1016/j.ajpc.2022.100336