Ascvd risk statin
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Statin Use and ASCVD Risk: Insights from Recent Research
Statin Therapy for ASCVD Prevention in Breast Cancer Patients
ASCVD Risk in Breast Cancer Survivors
Breast cancer (BC) survivors face a significant risk of atherosclerotic cardiovascular disease (ASCVD), which is a leading cause of non-cancer mortality in this population. A study conducted on BC patients diagnosed between 2009 and 2015 revealed that a majority of these patients had indications for lipid-lowering therapy at the time of BC diagnosis. Despite this, 43% of patients were never prescribed a statin, highlighting a gap in primary prevention efforts.
Statin Prescription Patterns
The study found that 64% of BC patients had an established indication for statin therapy, but only 35% were prescribed a statin at baseline, and 57% at any time during the study period. This indicates a need for improved ASCVD prevention strategies during BC treatment and follow-up.
Predictors of ASCVD Events in Statin-Treated Patients
Biomarkers and ASCVD Risk
In patients with acute coronary syndrome (ACS) receiving high-intensity statin therapy, levels of LDL cholesterol (LDL-C), lipoprotein(a) [Lp(a)], and high-sensitivity C-reactive protein (hsCRP) were found to be independent predictors of major adverse cardiovascular events (MACE). Both LDL-C and hsCRP were also associated with all-cause death, underscoring the importance of these biomarkers in risk stratification.
Residual ASCVD Risk
Despite statin therapy, many patients continue to experience ASCVD events. A study developed a 5-year risk prediction model for statin-treated patients with known ASCVD, identifying factors such as male sex, hemoglobin A1c, and family history of cardiovascular disease as significant predictors of residual risk. Another study highlighted that specific risk factors and subclinical atherosclerosis measures, such as coronary artery calcium score, are strong predictors of residual ASCVD risk in statin-treated adults without known ASCVD.
Combination Therapies to Enhance ASCVD Risk Reduction
Ezetimibe and Statin Combination
For patients who do not achieve LDL-C targets with statin monotherapy, adding ezetimibe has been shown to provide additional LDL-C lowering and ASCVD risk reduction. Ezetimibe, when combined with statins, can lower LDL-C by an additional 25%, translating to significant ASCVD risk reduction without major safety concerns.
PCSK9 Inhibitors
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are another option for patients with high residual ASCVD risk despite maximally tolerated statin therapy. These inhibitors have shown promise in reducing recurrent ischemic events in high-risk populations, including those with familial hypercholesterolemia and diabetes mellitus.
Improving Statin Utilization and Adherence
Current Statin Use and Gaps
Data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 revealed that statin use for primary and secondary prevention of ASCVD remains suboptimal. Factors such as lack of routine care and healthcare coverage were associated with lower statin use. Addressing these gaps could prevent approximately one million ASCVD events over the next decade.
Role of Nontraditional Risk Markers
In individuals with an estimated 10-year ASCVD risk below 7.5%, nontraditional risk markers such as coronary artery calcium score and high-sensitivity C-reactive protein can help identify those who may benefit from statin therapy. This approach can improve risk assessment and guide statin allocation more effectively .
Conclusion
Statin therapy remains a cornerstone in the prevention of ASCVD, but there are significant opportunities to enhance its effectiveness through better risk assessment, combination therapies, and addressing barriers to statin use. By leveraging biomarkers, nontraditional risk markers, and adjunctive therapies like ezetimibe and PCSK9 inhibitors, healthcare providers can better manage and reduce ASCVD risk in diverse patient populations.
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