Transcript: Peter H Jones, MD, on Treatments for Dyslipidemia

Peter H Jones: Hi, I'm Dr. Peter Jones. I'm an associate professor of medicine at Baylor College of Medicine in the section of Cardiovascular Disease Prevention and I'm also the medical director of the Weight Management Services at Houston Methodist Hospital in Houston, Texas.

What I hope you've learned is how to identify high risk patients in your population where you can target specific lipid therapy to reduce the risk for future cardiovascular disease events which includes coronary heart disease, and stroke.

As we discussed, it's important that you understand that there are apoE containing lipid proteins such as LDL cholesterol particles and triglyceride rich lipoprotein particles that are directly causative of atherosclerosis. We've learned that from epidemiologic studies, randomized clinical trials, as well as genetic observations.

What we do know is that there are four basic patient groups who can benefit from lipid treatments, specifically statin therapy. We call these the four statin benefit groups.

Obviously, the first group are patients with established cardiovascular disease.

The second group are those who inherit very high cholesterol, called familial hypercholesterolemia, where they're exposed over their lifetime to high LDL cholesterol and can have premature heart disease. Those patients deserve to be treated early to lower their LDL cholesterol.

The third group are patients who don't have vascular disease, but have type two diabetes. They obviously are a very high risk for a future event and treating them specifically with lipid therapy can prevent their first event.

Probably the most difficult patient group and the fourth and last group are those patients who are pure primary prevention. They don't have vascular disease, do not have type two diabetes, but may be at high risk for coronary heart disease in the future. We talked about this group and how to identify them based on their future 10-year risk of coronary heart disease, and how to use other risk enhancing factors that may help you decide that they are at higher risk than they may be perceived to be.

One of those would be using coronary calcium scoring. An easy to obtain test that can give you a future risk of heart disease, depending on the presence of coronary calcium. Particularly it's important to recognize the power of zero. If a patient has zero coronary calcium, they're very low risk of heart disease, and you may be disinclined to give them future lipid treatment.

We discussed the lipid therapies that are available. Of course statins, everybody knows. But we do have randomized clinical trials that non static therapies that lower LDL cholesterol are also beneficial, such as ozanimod and the PCSK9 monoclonal antibody inhibitors.

And most importantly, we have some data about a triglyceride altering drug called icosapent ethyl, which is a pure EPA fish oil, that given at four grams a day reduced cardiovascular events in high risk patients as well.

So what I hope you've identified now are patients in your population who can benefit from a strategy of long term risk reduction for cardiovascular disease by looking at lipid therapy and utilizing it with long term success.