Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management
File(s)
Published version
Author(s)
Type
Journal Article
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.
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.
Date Issued
2017-06-03
Date Acceptance
2017-06-02
Citation
Atherosclerosis, 2017, 263, pp.112-118
ISSN
0021-9150
Publisher
Elsevier
Start Page
112
End Page
118
Journal / Book Title
Atherosclerosis
Volume
263
Copyright Statement
© 2017 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NCND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Subjects
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Peripheral Vascular Disease
Cardiovascular System & Cardiology
Atherosclerotic cardiovascular disease
Angina pectoris
Cardiovascular risk
Low density lipoprotein-cholesterol
Proprotein convertase subtilisin/kexin type 9 inhibitors
Primary prevention
ISCHEMIC-HEART-DISEASE
CORONARY-ARTERY-DISEASE
TASK-FORCE
SOCIETY GUIDELINES
THORACIC SURGEONS
AMERICAN-COLLEGE
ASSOCIATION
INTERVENTIONS
DYSLIPIDEMIA
ANGIOGRAPHY
Publication Status
Published