Kelsey E. Norman, PharmD, BCCP, BCACP, BCPS

Panelists discuss how evidence from a value-based care perspective demonstrates long-term health benefits, including reduced recurrent events and hospitalizations, as well as cost savings associated with intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies beyond statins in patients who are very high-risk post-atherosclerotic cardiovascular disease (ASCVD), while also addressing key challenges health care providers face in selecting nonstatin therapies and strategies to overcome them.

Panelists discuss how patients' access to and preferences for PCSK9 inhibitors and other treatments are influenced by factors such as insurance coverage, administration convenience, financial toxicity, and individual health concerns.

Panelists discuss how PCSK9 inhibitors, bempedoic acid, and inclisiran lower low-density lipoprotein cholesterol (LDL-C) through distinct mechanisms—PCSK9 inhibitors enhance LDL receptor recycling, bempedoic acid inhibits ATP citrate lyase to reduce cholesterol synthesis, and inclisiran uses RNA interference to decrease PCSK9 production—comparing their efficacy in reducing recurrent cardiovascular events.

Panelists discuss how medical professionals navigate statin initiation, considering contraindications or delays in specific patient populations, including those with liver disease or renal impairment, older adults, and other high-risk groups, while also examining evolving treatment patterns and factors influencing the adoption of more intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies.

Panelists discuss how the initiation of statin therapy requires careful consideration of contraindications and patient-specific factors, particularly in those with liver disease, renal impairment, or advanced age, while noting evolving treatment patterns toward more intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies based on individualized risk assessment.

Panelists discuss how statin therapy for primary prevention requires careful consideration of cardiovascular risk factors against potential adverse effects such as myalgia and liver abnormalities, generally favoring treatment when the calculated 10-year atherosclerotic cardiovascular disease [ASCVD] risk exceeds 7.5% to10% and adjusting recommendations based on individual patient factors including age, comorbidities, and preferences.

Panelists discuss how evolving clinical guidelines for intensive low-density lipoprotein cholesterol (LDL-C)–lowering therapies have shaped personalized treatment approaches through risk stratification, with different targets for primary vs secondary prevention and consideration of genetic factors when determining appropriate statin intensity.

Panelists discuss how cardiology practice has evolved toward more aggressive low-density lipoprotein cholesterol (LDL-C)–lowering strategies across specialties, with current guidelines generally recommending targets below 70 mg/dL for high-risk patients and even lower thresholds (below 55 mg/dL) for very high-risk individuals, though these targets require personalization based on age, comorbidities such as diabetes and hypertension, and other cardiovascular risk factors.

The panel concludes its discussion with insights on successful strategies that can inform optimal collaborative care practices for cardiovascular risk reduction in patients with ASCVD.

Clinical insights on how real-world treatment persistence and discontinuation rates compare between the various non-statin therapies and the factors that contribute to these differences.

The expert panel discusses the cost-effectiveness and clinical evidence gaps for non-statin therapies, including PCSK9 inhibitors, inclisiran, and bempedoic acid.

Focusing on PCSK9 inhibitors, inclisiran, and bempedoic acid, the panel compares treatment efficacy and outlines patient factors that influence treatment decisions.

Turning the focus to non-statin therapies, the panel outlines logistical barriers and discusses the characteristics that guide treatment selection in patients with ASCVD.

Clinical pharmacists discuss how to address key barriers that get in the way of implementing guideline-directed cholesterol treatment.

The panel compares the ACC/AHA cholesterol guidelines with the ESC/EAS guidelines and provides thoughts on how educational initiatives can be improved to increase familiarity and implementation.