There is some confusion about the differences between the European and American guidelines on lowering low-density lipoprotein (LDL) cholesterol, but it’s clear that lower is better, said Pam Taub, MD, FACC, professor of medicine, Division of Cardiovascular Medicine, UC San Diego School of Medicine.
There is some confusion about the differences between the European and American guidelines on lowering low-density lipoprotein (LDL) cholesterol, but it’s clear that lower is better, said Pam Taub, MD, FACC, professor of medicine, Division of Cardiovascular Medicine, UC San Diego School of Medicine.
Transcript
Both European and US multisociety dyslipidemia guidelines stress the importance of lowering low-density lipoprotein cholesterol. What needs to be adjusted in clinical practice to meet these guidelines and the goal levels?
So, I think there's a lot of confusion about what our ideal LDL should be. And I think the guidelines, unfortunately, contribute to some of this confusion. So, for instance, the American guidelines really endorse an LDL threshold less than 70 [mg/dL]. And what that means is that's the minimum that patients who've had prior events such as a heart attack or stroke should achieve. The European guidelines have a lower threshold of less than 55 [mg/dL].
And so, there some time is confusion among clinicians on what LDL levels should they be aiming for. And I think the message needs to come across: the lower the better. And I think it needs to be very clear that that 70 number that are in the AHA/ACC [American Heart Association/American College of Cardiology] guidelines is not a target, but it's a minimum threshold.
The other point I always like to emphasize is if someone has a myocardial infarction, let's say at an LDL of 100 [mg/dL], you don't really want to be getting them to an LDL of 70 [mg/dL]; you want to aim for a 50% reduction from that 100 [mg/dL], and to get them to an LDL goal of 50 [mg/dL]. So, there just needs to be more clarity, and that term threshold is kind of the minimum standard, and that if you have an LDL of 70 [mg/dL] for a secondary prevention patient, that's not enough, you need to get lower.
What we've also seen with a lot of studies, especially with the PCSK9 [roprotein convertase subtilisin/kexin type 9] inhibitors is the lower, the better. In some of the studies, we've seen that the LDL go as low as 20 [mg/dL]. And it's safe, and it's associated with improved outcomes. So, we need to be comfortable getting our LDLs even lower.
What I really do hope is both the European guidelines and the American guidelines will align so that there's one number that we can all remember, so there's less confusion.
Specialty Pharmacists at the Forefront: Elevating Care for Rare Diseases
May 1st 2024In the US, a disease is considered rare when it affects fewer than 200,000 persons, or 1 in every 1500 individuals, with an estimated total of 25 to 30 million Americans overall living with a rare disease at any given time.
Read More
Tackling Health Inequality: The Power of Education and Experience
April 30th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our final episode of this limited series and our conversation with Janine Jelks-Seale, MSPPM, director of health equity at UPMC Health Plan.
Listen
Latest Advances and Updates of Treatment in the Real World at AUA
May 1st 2024The annual meeting of the American Urological Association (AUA) not only presents the newest therapies coming out but showcases the latest in how treatments are being used in the real world, said Stephen Freedland, MD, of Cedars Sinai.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
The Federal Trade Commission (FTC) issued letters to 10 companies to warn them that certain drug patents were improperly listed; the US Department of Agriculture (USDA) will begin testing ground beef for bird flu particles; rural Americans are more likely to die early from 1 of the 5 leading causes of death than those who live in urban areas.
Read More