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Lipid Monitoring After Initiation of Lipid-Lowering Therapies: Return of Performance Measures?

  • Public Health Policy (SS Virani and D Mahtta, Section Editors)
  • Published:
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Abstract

Purpose of Review

The 2015 American College of Cardiology (ACC)/American Heart Association (AHA) Focused Update of Secondary Prevention Lipid Performance Measures removed low-density lipoprotein cholesterol (LDL-C) assessment as a performance measure. This review discusses the evidence supporting the importance of lipid monitoring in the secondary prevention of atherosclerotic cardiovascular disease (ASCVD).

Recent Findings

The 2018 AHA/ACC Multisociety cholesterol guideline (as did the 2013 guideline) recommends a lipid panel after initiating lipid-lowering therapy to monitor adherence and medication efficacy. The 2018 guideline also recommends adding nonstatin therapy in very-high-risk ASCVD patients with LDL-C ≥70 mg/dL despite maximally tolerated statin therapy.

Summary

The removal of LDL-C monitoring as a performance measure is not consistent with the 2018 cholesterol guidelines. Given the importance of monitoring lipid-lowering medication efficacy and adherence and optimally reducing LDL-C in very-high-risk patients with additional evidence-based nonstatin therapy, LDL-C assessment after initiating lipid-lowering therapy should be reinstated as a performance measure for patients with ASCVD.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Correspondence to Christie M. Ballantyne.

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Conflict of Interest

Matthew R. Deshotels declares no conflicts of interests.

Salim S. Virani receives research support from the US Department of Veterans Affairs, World Heart Federation, and Tahir and Jooma Family and has received an honorarium from the American College of Cardiology (as an associate editor for Innovations acc.org).

Christie M. Ballantyne has received grant/research support to his institution from Akcea, Amgen, Esperion, Ionis, Novartis, Regeneron, National Institutes of Health, and American Heart Association and is a consultant for Althera, Amarin, Amgen, Arrowhead, AstraZeneca, Corvidia, Esperion, Genentech, Gilead, Matinas BioPharma Inc., New Amsterdam, Novartis, Novo Nordisk, Pfizer, Regeneron, and Sanofi-Synthelabo.

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Deshotels, M.R., Virani, S.S. & Ballantyne, C.M. Lipid Monitoring After Initiation of Lipid-Lowering Therapies: Return of Performance Measures?. Curr Cardiol Rep 23, 116 (2021). https://doi.org/10.1007/s11886-021-01545-9

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