1b) Dr. Taub is a clinician/scientist and is a frequent contributor to our #accredited programs. She is the founding director of the Step Family Foundation Cardiac Rehabilitation and Wellness Center at #UCSD.#FOAMed #cardiotwitter @medtweetorials #MedEd #lipids pic.twitter.com/rtBC1LMdZZ
— cardio-met (@cardiomet_CE) June 2, 2023
3) Cardiovascular disease (#CVD) is #1 cause of ☠️in 🇺🇸 & 🇪🇺. #Dyslipidemia is one of the primary causal factors in development of #atherosclerotic CVD (#ASCVD), guidelines rec tx of dyslipidemia for both primary & secondary prevention of ASCVD. pic.twitter.com/lLkHYGcfsF
— cardio-met (@cardiomet_CE) June 2, 2023
5a) Alternative & new drug classes have demonstrated further #CV event reduction when subbed for or added to #statins. See https://t.co/fC7MS6JsfF for more 🆓CE/#CME on @nationallipid guidance on these drugs, found at 🔓https://t.co/GTHrtveS8v. pic.twitter.com/NcIw7DeYwc
— cardio-met (@cardiomet_CE) June 2, 2023
6) We have made so much progress in lipid lowering therapies #LLT since the introduction of #statins in 1987.
— cardio-met (@cardiomet_CE) June 2, 2023
Yet many patients are stuck with statin monotherapy or have statin intolerance and do not achieve their #LDL goals.
7b) CLEAR Outcomes received an encore presentation at #NLA23, with Leslie Cho MD of @clevelandclinic this time doing the honors. pic.twitter.com/DRTgef4Yly
— cardio-met (@cardiomet_CE) June 2, 2023
9a) Let’s delve into some of the unique aspects of the #CLEAR_OUTCOMES study.
— cardio-met (@cardiomet_CE) June 2, 2023
Women have been poorly represented in clinical trials of lipid lowering agents.
Take a look at some of the major landmark clinical trials and the percentage of women enrolled: pic.twitter.com/ClTEaoZAg8
10a) A post hoc analysis of 4 studies for #bempedoic_acid demonstrated that a greater ratio of women experienced LDL-C reduction by 30% compared to men (OR 1.643, p<0.0096)
— cardio-met (@cardiomet_CE) June 2, 2023
🔓 https://t.co/QROgFWbKwH
🔓 https://t.co/F2Bsn8HJTJ
10c) Thus could the combination of #ezetimibe and #bempedoic acid have more benefit in women?
— cardio-met (@cardiomet_CE) June 2, 2023
We need more studies!
12) Overall, #bempedoic acid was well tolerated with a slightly increased incidence of #gout (3.1% versus 2.1%) and cholelithiasis (2.2% versus 1.2%). The incidence of tendon rupture was low at 1.2%.
— cardio-met (@cardiomet_CE) June 2, 2023
14a) We know that #inflammation is a driver of #atherosclerosis, and we have seen in clinical trials such as #CANTOS that decreasing inflammation (without additional LDL lowering) ⬇️#CV risk.
— cardio-met (@cardiomet_CE) June 2, 2023
See 🔓https://t.co/rb6zGy8i1W
14c) 🆕In CLEAR OUTCOMES there was a 19.4% ⬇️in #hsCRP at the end of the study.
— cardio-met (@cardiomet_CE) June 2, 2023
It will be interesting in future analyses to see if there is a higher degree of hsCRP lowering in primary prevention cohorts, & to determine if this is driving the increased benefit in this subgroup.
16) Lp(a) is the evil diabolical cousin of #LDL. It is an LDL-like particle but has more thrombotic and atherogenic properties due its additional domains such as #apo(a). pic.twitter.com/Ft7nI7Z5qS
— cardio-met (@cardiomet_CE) June 2, 2023
18) In the 2018 @ACCinTouch #Cholesterol guidelines, Lp(a) is an #ASCVD risk enhancer pic.twitter.com/i4mamTePv2
— cardio-met (@cardiomet_CE) June 2, 2023
20) Currently the only class of drugs available that lowers Lp(a) levels is #PCSK9 inhibitors.
— cardio-met (@cardiomet_CE) June 2, 2023
There are many ongoing phase III clinical trials with Lp(a) lowering drugs including #pelacarsenand #olpasiran. pic.twitter.com/fvubBZWQjU
22) We currently do not recommend aspirin #ASA for primary prevention, but in individuals with elevated Lp(a) there maybe benefit, as Lp(a) is a #prothrombotic molecule. pic.twitter.com/pEoOJDsUEi
— cardio-met (@cardiomet_CE) June 2, 2023
23b) … but have failed to clearly reduce #CVD events. #PCSK9i reduce cholesterol & Lp(a) and also reduce CVD events.
— cardio-met (@cardiomet_CE) June 2, 2023
24) Finally, we turn our attention to the issue of #guidelines and how to incorporate emerging and newly validated #LLT into optimal patient care. This is of course an engaging 🧵 among attendees at #NLA23.
— cardio-met (@cardiomet_CE) June 2, 2023
26) More broadly, we have the 2022 @ACCinTouch Expert Consensus statement to fills in data & guidance gaps.
— cardio-met (@cardiomet_CE) June 2, 2023
🔓 https://t.co/H5YfYuuTU7 pic.twitter.com/IhlrhF4gse
28) In addition, in the expert consensus statement combination therapy is encouraged with #ezetimbe, #bempeodic acid, #PCSK9 inhibitor or #inclisiran to reach that target.
— cardio-met (@cardiomet_CE) June 2, 2023
30) In the #GOULD registry of 5006 patients with #ASCVD, only 17% had intensification of lipid lowering therapy after 2 years.
— cardio-met (@cardiomet_CE) June 2, 2023
Patients needed combination #LLT to reach #LDL targets.
🔓 https://t.co/iUkFlP059t , led by core @cardiomet_cefaculty @cpcannon pic.twitter.com/cLEjwC9KdI
32) A lesson from leading authorities echoed at #NLA23: We are comfortable using combination therapy to reach #bloodpressure & #HbA1c tx goals . . . we need to move beyond #statin monotherapy for our pts w/ #hyperlipidemia. In 2023 we have so many non-statin options available!
— cardio-met (@cardiomet_CE) June 2, 2023
33b) You got this, right? It’s d, #bempedoic acid and #ezetimbibe. Compounding the absence of #statins from this list is the finding that women are more likely to suffer adverse effects from statin therapy than are men.
— cardio-met (@cardiomet_CE) June 2, 2023
34b) It’s c, #PCSK9i. That’s a bit of a trick question, as #CETPi does appear to lower Lp(a) levels, but to date has not been associated with event reduction.
— cardio-met (@cardiomet_CE) June 2, 2023
35) And, live from #NLA23, you just earned .75h 🆓CE/#CME! Claim your certificate at https://t.co/3ANcp9yJQN, and FOLLOW @cardiomet_ce for the latest #cardiometabolic #MedEd delivered wholly on Twitter! @PamTaubMD & @academiccme thank you for joining us!
— cardio-met (@cardiomet_CE) June 2, 2023