iForumRx.org
An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

July 6, 2020

Lipid management continues to be an essential component in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).  For the past decade, clinical practice guidelines have gone back and forth about optimal treatment goals but guidelines all agree that statins should be used as the preferred initial therapy. However, there is still a lack of clarity about the optimal add-on therapies. The newest LDL-lowering therapy is inclisiran, a small interfering RNA (siRNA) that targets the PCSK9 pathway.

Guest Authors:  Joshua O. Holmes, PharmD, MS and Amanda Schartel, PharmD, BCACP

Music by Good Talk

Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

February 22, 2019

Although hypertriglyceridemia has consistently been associated with increased CV events, medications that lower triglycerides have failed to reel in a significant reduction in major CV events when combined with statin therapy. Could purified fish oil derivatives be the answer? Or just another red herring? The Reduction of CV Events with Icosapent-Ethyl Intervention Trial (REDUCE-IT) sought to clarify the utility of icosapent ethyl, a highly purified EPA derivative.

Guest Authors: Melissa Norton, PharmD and Elizabeth A. Cook, PharmD, AE-C, BCACP, CDE

Music by Good Talk

Top Ten Things Every Clinician Should Know About the 2018 Cholesterol Guidelines

Top Ten Things Every Clinician Should Know About the 2018 Cholesterol Guidelines

January 9, 2019

The American Heart Association / American College of Cardiology (AHA/ACC) Task Force recently published the 2018 Guideline on the Management of Blood Cholesterol. The guidelines writing committee had representation from 12 organizations, including the National Lipid Association, American Diabetes Association, and the American Pharmacists Association — all of whom endorsed the guidelines. The previous guidelines (published in 2013) were intended to answer some specific clinical questions and significantly changed our approach to treatment. The 2018 guidelines provide a more comprehensive set of recommendations, akin to the (older) National Heart, Lung, and Blood Institute Adult Treatment Panel (ATP) III guidelines last published in 2002!

Guest Authors:  Dawn Fuke, Pharm.D., BCPS, and Zach Conroy, PharmD, BCACP

Music by Good Talk

LDL Limbo: How Low is Too Low?

LDL Limbo: How Low is Too Low?

October 26, 2018

There has been significant debate regarding the safety of achieving very low LDL-C levels, including a potential negative impact on cognitive function. The current ACC/AHA guidelines (circa 2013) suggest decreasing the statin dose in patients with two consecutive LDL-C levels below 40 mg/dL based on expert opinion. The lack of evidence has been a major challenge for clinicians and it is unclear whether medication doses should be reduced in high-risk patients who may benefit from very low LDL-C levels.  A recently published meta-analysis sought to address this clinical dilemma.

Podcast Case: Very Low LDL Case

Guest Authors:  Apryl Anderson, PharmD and Dave Dixon, PharmD, BCPS, BCACP, CLS, CDE

Music by Good Talk

 

Are Statins ALL THAT for Primary Prevention in Older Adults? A Second Look at ALLHAT-LLT

Are Statins ALL THAT for Primary Prevention in Older Adults? A Second Look at ALLHAT-LLT

August 25, 2017

Statins reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, the utility of statin therapy in older adults — particularly in those age 75 years and older — remains controversial. The need for additional evidence to guide clinical practice is underscored by the fact that one-in-three older Americans report taking a statin.  Given the paucity of prospective data, a post-hoc analysis of the ALLHAT-LLT (Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial - Lipid Lowering Trial) was recently published.  Does this new analysis really help inform the decision?

Guest Author:  Leo Buckley, Pharm.D.

Music by Good Talk

HIP-HIP-HOPE-3! Expanded role for statin therapy for primary prevention

HIP-HIP-HOPE-3! Expanded role for statin therapy for primary prevention

September 15, 2016

The HOPE-3 trial sought to determine if blood pressure (BP) and cholesterol-lowering therapies are effective and safe as primary prevention strategies in intermediate risk patients. The American College of Cardiology and American Heart Association (ACC/AHA) guidelines support a risk-based approach to statin use but in intermediate risk patients the tradeoffs between benefit and risk were deemed “less clear.”  Do the results of HOPE-3 trial provide enough evidence to support routinely treating intermediate risk patients?

PCSK9 Inhibitors: Blockbusters or Bust?

PCSK9 Inhibitors: Blockbusters or Bust?

September 5, 2015

Two new mAbs, alirocumab and evolocumab, have been approved to treat elevated cholesterol when added to maximally tolerated statin therapy in patients with familial hypercholesterolemia or history of atherosclerotic cardiovascular disease (ASCVD). This new class of drugs, the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, is considered to be the biggest breakthrough in cholesterol treatment since statins were approved 3 decades ago. But are they worth it?

CVD Risk Scores - Are They Accurate?

CVD Risk Scores - Are They Accurate?

July 28, 2015

How well do cardiovascular disease risk calculators really perform?  Do they over or underestimate risk?  Should we rely on them to make treatment decisions?

Potential Uses of Niacin: Flushing Out The Results of HPS2-THRIVE

Potential Uses of Niacin: Flushing Out The Results of HPS2-THRIVE

February 16, 2015

Guidelines promote the use of statins as first line therapy to prevent atherosclerotic cardiovascular disease events. Does adding niacin to statin treatment reduce residual risk?