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Determining When to Add Nonstatin Therapy: A Quantitative Approach.

Publication ,  Journal Article
Robinson, JG; Huijgen, R; Ray, K; Persons, J; Kastelein, JJP; Pencina, MJ
Published in: J Am Coll Cardiol
December 6, 2016

BACKGROUND: Costs and uncertainty about the benefits of nonstatin therapies limit their use. OBJECTIVES: The authors sought to identify patients who might benefit from the addition of a nonstatin to background statin therapy. METHODS: We performed systematic reviews of subgroup analyses from randomized trials and observational studies with statin-treated participants to determine estimated 10-year absolute risk of atherosclerotic cardiovascular disease (ASCVD) and to define high-risk and very high-risk patients. We used the relative risk reductions for the addition of a nonstatin to lower low-density lipoprotein (LDL-C) used to determine the number needed to treat (NNT) to prevent 1 ASCVD event over 5 years for each patient group and to allow comparisons with 5-year cost analyses. RESULTS: The 10-year ASCVD risk is at least 30% (very high risk) for statin-treated participants with clinical ASCVD and comorbidities, and 20% to 29% (high risk) for those with ASCVD without comorbidities or who have heterozygous familial hypercholesterolemia. Adding ezetimibe to reduce low-density LDL-C by 20% would provide a 5-year NNT ≤50 for very high-risk patients with LDL-C ≥130 mg/dl or for high-risk patients with LDL-C ≥190 mg/dl, and an NNT ≤30 for very high-risk patients with LDL-C ≥160 mg/dl. Adding a PCSK9 monoclonal antibody to lower LDL-C by at least 50% would provide an NNT ≤50 for very high-risk and high-risk patients with LDL-C ≥70 mg/dl, and an NNT ≤30 for very high-risk and high-risk patients with an LDL-C ≥130 mg/dl. CONCLUSIONS: Adding ezetimibe or PCSK9 monoclonal antibodies to maximally tolerated statin therapy may be cost effective in very high-risk and high-risk patients, depending on baseline LDL-C levels.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 6, 2016

Volume

68

Issue

22

Start / End Page

2412 / 2421

Location

United States

Related Subject Headings

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Drug Therapy, Combination
  • Cost-Benefit Analysis
  • Cardiovascular System & Hematology
  • Atherosclerosis
  • Anticholesteremic Agents
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Robinson, J. G., Huijgen, R., Ray, K., Persons, J., Kastelein, J. J. P., & Pencina, M. J. (2016). Determining When to Add Nonstatin Therapy: A Quantitative Approach. J Am Coll Cardiol, 68(22), 2412–2421. https://doi.org/10.1016/j.jacc.2016.09.928
Robinson, Jennifer G., Roeland Huijgen, Kausik Ray, Jane Persons, John J. P. Kastelein, and Michael J. Pencina. “Determining When to Add Nonstatin Therapy: A Quantitative Approach.J Am Coll Cardiol 68, no. 22 (December 6, 2016): 2412–21. https://doi.org/10.1016/j.jacc.2016.09.928.
Robinson JG, Huijgen R, Ray K, Persons J, Kastelein JJP, Pencina MJ. Determining When to Add Nonstatin Therapy: A Quantitative Approach. J Am Coll Cardiol. 2016 Dec 6;68(22):2412–21.
Robinson, Jennifer G., et al. “Determining When to Add Nonstatin Therapy: A Quantitative Approach.J Am Coll Cardiol, vol. 68, no. 22, Dec. 2016, pp. 2412–21. Pubmed, doi:10.1016/j.jacc.2016.09.928.
Robinson JG, Huijgen R, Ray K, Persons J, Kastelein JJP, Pencina MJ. Determining When to Add Nonstatin Therapy: A Quantitative Approach. J Am Coll Cardiol. 2016 Dec 6;68(22):2412–2421.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 6, 2016

Volume

68

Issue

22

Start / End Page

2412 / 2421

Location

United States

Related Subject Headings

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Humans
  • Drug Therapy, Combination
  • Cost-Benefit Analysis
  • Cardiovascular System & Hematology
  • Atherosclerosis
  • Anticholesteremic Agents
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
  • 1102 Cardiorespiratory Medicine and Haematology