Implementation Issues for Non-Statin Therapies

Sunday, March 20 at 10:30 am

NEW ORLEANS—Physicians face a few issues when prescribing non-statin therapies to lower patients’ low-density lipoprotein (LDL) cholesterol, including how to prescribe them and who to prescribe them to. However, in a recent presentation, Dr. Margo Minissian broke down each issue and explained how physicians can properly prescribe non-statin therapies.

Margo B. Minissian, PhDc, ACNP, CLS, AACC, FAHA, is a Nurse Scientist, Cardiology Nurse Practitioner, and Clinical Lipid Specialist at Cedars-Sinai Women’s Heart Center in Los Angeles, CA.

In her session, “Practical Issues in the Implementation of Non-Statin Therapy,” Minissian described how to use currently available non-statin agents to lower LDL based on targets in lipoprotein synthesis, transport, and regulation; outlined clinical trial data on the therapies’ efficacy and safety; explained how to apply strategies for implementing them in the clinical setting; discussed barriers to use; and discussed who should receive the treatment.

According to Minissian, a few non-statin medications can be prescribed to lower cholesterol, which she further diagramed in her session:

  • Cholesterol absorption inhibitors,
  • Antisense ApoB inhibitors,
  • MTTP inhibitors,
  • Vitamin B3 essential human nutrients,
  • Moderate agonism of peroxisome proliferator–activated receptor-α, or
  • PCSK9 inhibitors.

She suggested physicians consider non-statin use when the (1) patient can’t reach LDL targets with diet, exercise, and current statin regimen or the patient continues to have events; (2) patient can’t reach LDL targets because of statin intolerance; or (3) patient doesn’t reach LDL target after receiving high-dose statins. Physicians can consider combination therapy when cholesterol is reduced less than 50% or when LDL-C is at 100 mg/dL or more.

In addition, Minissian mentioned 4 groups of patients who can benefit from additional reduction of LDL:

  • Patients with clinical atherosclerotic cardiovascular disease (ASCVD),
  • Patients with diabetes aged 40 to 74 years,
  • Patients with familial hyperlipidemia, and
  • Patients in primary prevention without diabetes and with an ASCVD 10-year risk of more than 7.5 mg/dL.

“Clinician and patient issues should be considered before prescribing non-statins,” Minissian recommended. “Prescribing newer medications will require extra documentation, and clinicians should consider tools to facilitate the documentation.”

She also noted that the American College of Cardiology and American Heart Association 2013 Blood Cholesterol Guideline can help physicians prescribe non-statins for certain patients and that they are re-evaluating the guideline on treating high blood cholesterol as clinical practice shifts toward more assertive treatment.

—Amanda Balbi