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 [F] Diseases Research  / PubMed Research Articles  /
Detection of atherosclerotic cardiovascular disease influences the perceived need for aggressive lipid management.




Atherosclerosis 2017 Jun 17; 263()


Mancini GBJ1; Gupta M2; Tsigoulis M3; Cannon CP4; Genest J5; Ray KK6; Santos RD7; Watts GF8; Raggi P9;

Author Information
  • 1University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
  • 2McMaster University, Hamilton, Ontario, Canada; Canadian Collaborative Research Network, Brampton, Ontario, Canada.
  • 3Canadian Collaborative Research Network, Brampton, Ontario, Canada.
  • 4Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
  • 5McGill, Montreal, Quebec, Canada.
  • 6Imperial Centre for Cardiovascular Disease Prevention, Department of Public Health and Primary Care at Imperial College London and Imperial College NHS Trust, London, England, United Kingdom.
  • 7Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil.
  • 8Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
  • 9Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.


BACKGROUND AND AIMS: Overt atherosclerotic cardiovascular disease (ASCVD) warrants aggressive lipid lowering. Imaging for ambiguous symptoms suggesting ischemia or for clarification of CV risk in asymptomatic individuals often uncovers previously unknown ASCVD. Guidelines do not provide clear recommendations for aggressive lipid lowering in such cases. We explored physicians' perception, as influenced by tests that detect ASCVD, regarding appropriateness of getting to lipid goals and for theoretically accessing proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i).

METHODS: A questionnaire was developed including cases of low to high CV risk, chronic kidney disease (CKD) or type 2 diabetes mellitus (T2DM). Each case was considered with or without angina symptoms and, in turn, whether testing identified previously unknown advanced, early/subclinical or no ASCVD. Synthesis of responses was facilitated by using a scale for perceived appropriateness from 1 (lowest) to 9 (highest).

RESULTS: Getting to goal and, if not achieved by statins and/or ezetimibe, accessing PCSK9i was considered appropriate in patients with T2DM with preclinical or advanced ASCVD, patients with moderate or high CV risk and advanced ASCVD, patients with CKD or low CV risk with angina symptoms and advanced ASCVD. For most of the remaining cases adding PCSK9i was considered only possibly appropriate.

CONCLUSIONS: Physicians' perception of appropriateness for achieving lipid goals, including access to PCSK9i, is markedly influenced by detection of previously unknown ASCVD. Since these commonly encountered scenarios do not clearly meet current indications for PCSK9i, our data identify pressing areas requiring further research.

Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.




Publication Type: Journal Article

This article is licensed under the the National Library of Medicine License. It uses material from the PubMed National Library of Medicine Data.

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