Enhancing Patient Care Through Guideline Adherence

Dr Leandro N. Slipczuk highlights the importance of cardiovascular treatment guidelines when deciding on patient care for those with ASCVD.

Leandro N. Slipczuk, MD, PhD: It’s important for all providers who are treating patients to understand which patients are at very high risk. And this concept has been evolving over time. When we compare the 2018 ACC/AHA [American College of Cardiology/American Heart Association] guidelines to the more recent European guidelines, we see a trend. We see a trend to identify these very high-risk patients and understand something that has come from recent trials, that patients who have already had ASCVD [atherosclerotic cardiovascular disease] have very high risk. For example, patients who have ASCVD and multiple comorbidities, such as hypertension, CKD [chronic kidney disease], diabetes, smoking, patients who have a phage with ASCVD, patients who have severe chronic kidney disease. For all these patients, the lower we bring their LDL [low-density lipoprotein] cholesterol, the lower the risk. And the sooner we do this, also, the lower the risk.

Understanding this, the newer guidelines have switched to identify these very high-risk patients and recommending an LDL below 55 [mg/dL]. This is a transition from the prior guidelines from 2018 that identified less than 70 [mg/dL], to go even further, less than 55 [mg/dL]. If we have recurrent events in patients who are below 55 [mg/dL], the recommendation is to consider below 40 [mg/dL]. We know now that it’s safe and we know that it’s achievable, and we have the tools for it. I think this has been a great transition in the guidelines in keeping up with the data from clinical trials.

This transcript has been edited for clarity.

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