CHOLESTEROL GOALS & TARGETS: SHOULD WE IMPROVE IT?



Laurence Sperling, M.D., Emory University School of Medicine, Atlanta, GA, USA

Appropriate intensity statins are recommended by the ACC/ AHA Blood Cholesterol Guidelines as first line lipid therapy for both high risk secondary prevention patients with established atherosclerotic cardiovascular disease (ASCVD) and post-acute coronary syndrome (ACS). The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) is the first randomized prospective clinical outcomes trial to demonstrate that stain therapy plus a non-statin agent (ezetimibe) reduced ASCVD events (6.4% relative risk reduction of the primary composite endpoint). It is likely this study will impact future guideline recommendations. Despite established benefits of statin therapy for secondary prevention there appears to be substantial underutilization of well-validate guideline-directed therapies, and a significant lack of medication adherence. Strategies to assess gaps in care delivery, improve awareness of guideline-driven recommendations, and patient adherence to therapies may be more important ways to IMPROVE-IT.