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Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management.

Abstract：

BACKGROUND AND AIMS:Overt atherosclerotic cardiovascular disease (ASCVD) warrants aggressive lipid lowering. Imaging for ambiguous symptoms suggesting ischemia or for clarification of CV risk in asymptomatic individuals often uncovers previously unknown ASCVD. Guidelines do not provide clear recommendations for aggressive lipid lowering in such cases. We explored physicians' perception, as influenced by tests that detect ASCVD, regarding appropriateness of getting to lipid goals and for theoretically accessing proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). METHODS:A questionnaire was developed including cases of low to high CV risk, chronic kidney disease (CKD) or type 2 diabetes mellitus (T2DM). Each case was considered with or without angina symptoms and, in turn, whether testing identified previously unknown advanced, early/subclinical or no ASCVD. Synthesis of responses was facilitated by using a scale for perceived appropriateness from 1 (lowest) to 9 (highest). RESULTS:Getting to goal and, if not achieved by statins and/or ezetimibe, accessing PCSK9i was considered appropriate in patients with T2DM with preclinical or advanced ASCVD, patients with moderate or high CV risk and advanced ASCVD, patients with CKD or low CV risk with angina symptoms and advanced ASCVD. For most of the remaining cases adding PCSK9i was considered only possibly appropriate. CONCLUSIONS:Physicians' perception of appropriateness for achieving lipid goals, including access to PCSK9i, is markedly influenced by detection of previously unknown ASCVD. Since these commonly encountered scenarios do not clearly meet current indications for PCSK9i, our data identify pressing areas requiring further research.

journal_name

Atherosclerosis

journal_title

Atherosclerosis

authors

Mancini GBJ,Gupta M,Tsigoulis M,Cannon CP,Genest J,Ray KK,Santos RD,Watts GF,Raggi P

doi

10.1016/j.atherosclerosis.2017.06.006

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

112-118

eissn

0021-9150

issn

1879-1484

pii

S0021-9150(17)30255-1

journal_volume

263

pub_type

杂志文章

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