Selected recommendations on intensification of lipid-lowering therapy
In patients with ASCVD on maximally tolerated statin dose, intensification of lipid-lowering therapy is recommended with:
- A PCSK9 inhibitor ± ezetimibe for secondary CV prevention in patients with LDL-C ≥ 1.8 mmol/L who are appropriate for PSCK9 inhibitor therapy (Assigned a strong recommendation based on moderate quality evidence)
- Ezetimibe and/or a PCSK9 inhibitor for all secondary prevention CVD patients in whom LDL-C remains ≥ 1.8 mmol/L (or non-HDL-C ≥ 2.4 mmol/L or ApoB ≥ 0.7 g/L). PCSK9 inhibitor therapy is recommended if LDL-C remains ≥ 1.8 mmol/L on initial ezetimibe therapy. (Assigned a strong recommendation based on high quality evidence)
Additional lipid-lowering therapy with ezetimibe and PCSK9 inhibitors may also be considered for ASCVD patients with an LDL-C < 1.8 mmol/L, especially those at high risk for recurrent ASCVD events.
Please see the complete guidelines for all 2021 CCS Dyslipidemia Guideline recommendations.
ASCVD: Myocardial infarction (MI), acute coronary syndromes (ACS); stable angina, documented coronary artery disease using angiography; stroke, TIA, documented carotid disease; peripheral arterial disease, claudication, and/or ABI < 0.9; abdominal aortic aneurysm (AAA)—abdominal aorta > 3.0 cm or previous aneurysm surgery.
* An LDL-C treatment threshold of ≥ 1.8 mmol/L (or non-HDL-C ≥ 2.4 mmol/L or ApoB ≥ 0.7 g/L) is recommended for intensifying lipid-lowering therapy with a PCSK9 inhibitor (± ezetimibe) in secondary CV prevention
patients on maximally tolerated statin dose. The addition of a PCSK9 inhibitor (± ezetimibe) is recommended for patients shown to be appropriate for these agents.
ABI=ankle–brachial index; ASCVD=atherosclerotic cardiovascular disease; FH= familial hypercholesterolaemia; HDL-C=high-density lipoprotein cholesterol; LDL-C=low-density
lipoprotein cholesterol; PCSK9=proprotein convertase subtilisin/kexin type 9; TIA=transient ischemic attack.
