scholarly journals LDL-Cholesterol-Lowering Therapy

2020 ◽  
Author(s):  
Angela Pirillo ◽  
Giuseppe D. Norata ◽  
Alberico L. Catapano
Keyword(s):  
Ldl Cholesterol ◽  
Cholesterol Lowering ◽  
Lowering Therapy

Cholestanol: A serum marker to guide LDL cholesterol-lowering therapy

2006 ◽  
Vol 184 (2) ◽  
pp. 247-254 ◽  
Author(s):  
Michel R. Hoenig ◽  
Barbara E. Rolfe ◽  
Julie H. Campbell
Keyword(s):  
Ldl Cholesterol ◽  
Serum Marker ◽  
Cholesterol Lowering ◽  
Lowering Therapy

Intensive LDL-cholesterol lowering therapy and neurocognitive function

2017 ◽  
Vol 170 ◽  
pp. 181-191 ◽  
Author(s):  
Maciej Banach ◽  
Manfredi Rizzo ◽  
Dragana Nikolic ◽  
George Howard ◽  
VirginiaJ. Howard ◽  
...  
Keyword(s):  
Ldl Cholesterol ◽  
Neurocognitive Function ◽  
Cholesterol Lowering ◽  
Lowering Therapy

ID: 19: ELIGIBILITY FOR PCSK9 TREATMENT IN 734 HYPERCHOLESTEROLEMIC PATIENTS REFERRED TO A REGIONAL CHOLESTEROL TREATMENT CENTER WITH LDL CHOLESTEROL ≥70 MG/DL DESPITE MAXIMAL TOLERATED CHOLESTEROL LOWERING THERAPY

2016 ◽  
Vol 64 (4) ◽  
pp. 931.2-932
Author(s):  
P Shah ◽  
CJ Glueck ◽  
N Goldenberg ◽  
V Jetty ◽  
A Kumar ◽  
...  
Keyword(s):  
Conventional Treatment ◽  
Ldl Cholesterol ◽  
Inhibitor Therapy ◽  
Atherosclerotic Cardiovascular Disease ◽  
Pcsk9 Inhibitors ◽  
Cholesterol Lowering ◽  
Commercial Insurance ◽  
Pcsk9 Inhibitor ◽  
Lowering Therapy ◽  
Insurance Criteria

BackgroundLDL cholesterol (LDLC) lowering has been revolutionized by PCSK9 inhibitors, Alirocumab (Praluent) and Evolocumab (Repatha), which have approved indications as an adjunct to diet-maximally tolerated cholesterol lowering therapy in heterozygous (HeFH) or homozygous (HoFH) familial hypercholesterolemia, and/or clinical atherosclerotic cardiovascular disease (CVD) where LDLC lowering is insufficient despite maximal tolerated therapy.MethodsWe applied FDA approved and commercial insurance eligibility criteria for PCSK9 inhibitor use in 734 patients serially referred over 3 years who then received ≥2 months maximally tolerated LDLC lowering diet-drug therapy with follow up LDLC ≥70 mg/dl, as well as in 37 patients approved by commercial insurance for PCSK9 inhibitors. We obtained estimates of the percentage of patients with HeFH and/or CVD who meet FDA and commercial insurance eligibility for PCSK9 inhibitors using LDLC goal-based guidelines.ResultsOf the 734 patients with LDLC ≥70 mg/dl after ≥2 months maximally tolerated LDLC lowering therapy, 220 (30%) had HeFH and/or CVD events with LDLC >100 mg/dl, meeting both FDA and commercial insurance criteria for PCSK9 inhibitor therapy. Sixty-six (9%) patients were statin intolerant, without HeFH or CVD events. Of the 37 patients whose PCSK9 inhibitor therapy was approved for coverage by medical insurance carriers, 34 (92%) had LDLC>100 mg/dl after ≥2 months on maximally tolerated LDLC lowering therapy. Sixteen (43%) of these 37 patients had HeFH without CVD (LDLC on maximally tolerated conventional treatment 181±48 mg/dl), 11 (30%) had CVD without HeFH (LDLC on maximally tolerated conventional treatment 122±22 mg/dl), and 8 (22%) had both HeFH and CVD (LDLC on maximally tolerated conventional treatment 204±56 mg/dl).ConclusionOf the 734 patients referred for high LDLC treatment, with LDLC ≥70 mg/dl after ≥2 months on maximally tolerated therapy, 220 (30%) had HeFH and/or CVD with LDLC >100 mg/dl, meeting both FDA and insurance criteria for PCSK9 inhibitor therapy. If 30% of patients with high LDLC and HeFH-CVD are eligible for PCSK9 inhibitors, then specialty pharmaceutical pricing models (∼$14,300/year) will collide with an estimated 16–21 million HeFH-CVD patients. Although the costs for PCSK9 inhibitors given to an estimated 16 to 21 million patients are extraordinary ($228–300 billion), we speculate that, when weighed against direct and indirect costs of CVD, on balance, the cost to society might be either none, or that society would, in fact, save money by an anticipated 50% reduction of CVD events with PCSK9 inhibitors. Whether the health care savings arising from the anticipated reduction of CVD on the PCSK9 inhibitors justify the broad population use of these agents remains to be determined.

scholarly journals Small Dense LDL Cholesterol and Coronary Heart Disease: Results from the Framingham Offspring Study

2010 ◽  
Vol 56 (6) ◽  
pp. 967-976 ◽  
Author(s):  
Masumi Ai ◽  
Seiko Otokozawa ◽  
Bela F Asztalos ◽  
Yasuki Ito ◽  
Katsuyuki Nakajima ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ldl Cholesterol ◽  
Cholesterol Lowering ◽  
Small Dense Ldl ◽  
Lowering Therapy ◽  
Postmenopausal Status ◽  
Established Coronary Heart Disease ◽  
The Mean ◽  
Male Sex

Abstract Objective: We sought to establish reference values for a new direct assay for small dense LDL cholesterol (sdLDL-C) and to measure sdLDL-C concentrations in patients with established coronary heart disease (CHD) vs controls. Methods: Direct LDL-C and sdLDL-C were measured in samples from 3188 male and female participants of the Framingham Offspring Study, including 173 men and 74 women with CHD. Results: Postmenopausal status and male sex were associated with higher sdLDL-C concentrations (P < 0.0001). Cholesterol-lowering medication use was more frequent (P < 0.0001) in CHD patients than in controls (46.8% vs 11.4% in men; 35.1% vs 8.8% in women). In men, mean LDL-C was lower in CHD than in controls (3.22 vs 3.51 mmol/L, P < 0.0001), whereas mean sdLDL-C concentrations were similar (0.83 vs 0.84 mmol/L, P = 0.609). In women, mean LDL-C was similar in CHD and controls (3.53 vs 3.46 mmol/L, P = 0.543), but mean sdLDL-C was higher (0.83 vs 0.68 mmol/L, P = 0.0015). The mean percentage of LDL-C as sdLDL-C was higher in both men and women with CHD than controls (P < 0.01). Increased LDL-C and sdLDL-C were found in 10.4% and 22.0% of men and in 24.3% and 27.8% of women with CHD, respectively. Conclusions: Despite 4-fold greater cholesterol-lowering therapy use, CHD patients had mean LDL-C concentrations above the LDL-C goal of <2.6 mmol/L (<100 mg/dL). Although women with CHD had higher sdLDL-C concentrations than controls, this difference was not seen in men. These findings may explain some of the high residual risk of future CHD events in CHD patients.

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