1) High Cholesterol level and dyslipidemia: The relative reduction in CVD risk is proportional to the absolute size of the change in LDL-C, irrespective of the drug(s) used to achieve such change. (RCTs) indicate that lowering LDL-C safely reduces CVD risk even at low LDL-C levels( 55 mg/dl).
2) Risk Calculators predicting occurrence of Cardiovascular Disease based on underlying medical conditions.
A) ADVANCE -Diabetic patients can use this risk calculator.
B ) SMART RISK: Patients with underlying CVD Disease with prior history of heart attack or revascularization with stent.
C) The SCORE2 : European population with age< 70 and >40 without any underlying medical condition.
D ) ASCVD: American population age> 40 year.
E) SCORE2 OP: European population with age>70 without underlying medical condition.
3) Statin Medications: ( Atorvastatin/ Rosuvastatin/Pravastatin): The most frequent adverse effect of statin therapy is myopathy, but this is rare. A meta-analysis ruled out any contribution to an increase in non-CV mortality. Although 5–10% of patients receiving statins complain of myalgia. These patients can be offered Zetia. Statins are harmful in pregnancy and is not recommended.
PCSK 9 inhibitors: It decreases LDL-C by up to 60%, either as mono-therapy or in addition to the maximum tolerated dose of statin and/or other lipid-lowering therapies, such as ezetimibe. It is usually given by Sub Q injection bi weekly. PCSK9 inhibitors also lower triglycerides, raise HDL-C and apolipoprotein A-I, and lower lipoprotein(a), although the relative contributions of these lipid modifications remain unknown.
Newer Medicine :Inclisiran is a long-acting hepatic PCSK9 synthesis inhibitor that also lowers LDL-C levels considerably. Its effect on clinical outcomes remains to be established. It is usually given on day 1 and then 90 day( 3 months), followed by day 270( 9 months) and followed by day 450( 15 months).
Dr Bharat Marwaha, MD is practicing Cardiologist in U.S.A. He has published and presented more than 15 articles including in top 2 Journals of Cardiology in United States. He has received an “Academic Excellence Award” during his training. He has represented Ohio States at National Jeopardy Quiz Contest for doctors. He is a reviewer for Journal of Translation Medicine and Cureus.