2) This program is supported by an educational grant from Esperion Therapeutics & is intended for #HCPs. Statement of accreditation & faculty disclosures at https://t.co/gvXca4G9Xm. Earn .75hr 🆓CE/#CME by following this 🧵!@MedTweetorials
— cardio-met (@cardiomet_CE) November 13, 2023
4a) Let's start with an important presentation on 11/11 #AHA23 by Drs @emily_decicco & @AnnMarieNavar about lipid lowering therapy #LLT and #LDLC control for primary #ASCVD prevention in persons with #diabetes across 90 US health systems. pic.twitter.com/YDLEVsmfPb
— cardio-met (@cardiomet_CE) November 13, 2023
5a) Using the Cerner Real-World Data across 90 US health systems with #EHR, the authors evaluated use of lipid lowering therapy #LLT among 241,232 patients (53% ♀️) with #diabetes but without #ASCVD for #primary_prevention. #AHA23 pic.twitter.com/4Tq2ywRiCn
— cardio-met (@cardiomet_CE) November 13, 2023
6a) #LDLC control was suboptimal at baseline (37.0% and 27.9% had LDL-C ≥100 &<70 mg/dL, respectively). Patients with #diabetes with highest LDLC were more likely to be on no statin, and conversely, those with controlled LDLC more likely on high-intensity #statin. pic.twitter.com/Q9lTXrYQRF
— cardio-met (@cardiomet_CE) November 13, 2023
7a) So maybe these pts with #diabetes were on non-statins instead? Nope. There was suboptimal use of evidence-based non-statin LLT (i.e., #ezetimibe, #PCSK9i). Conversely there was significant use of #niacin & #fibrates, which do not have data supporting #CV outcome benefit. pic.twitter.com/QwhIJpDwWy
— cardio-met (@cardiomet_CE) November 13, 2023
8) In sum, this work identified significant care gaps among persons with #diabetes. Efforts are needed to improve #lipid management in this group at high CV risk. This work was simultaneously published in @AJPCardio: 🔓https://t.co/MLlbv14u5V pic.twitter.com/Qo9qNsNOT5
— cardio-met (@cardiomet_CE) November 13, 2023
10a) More from #AHA23! So, #hsCRP as a marker for #ASCVD risk.
— cardio-met (@cardiomet_CE) November 13, 2023
On 13NOV the esteemed #lipidologist #PaulRidkerMD presented 🆕 data from #CLEAR_OUTCOMES: #bempedoic_acid v placebo in 13,970 pts with #ASCVD or high #CV risk, #LDL_C 100+, & documented #statin intolerance. pic.twitter.com/jmXk7uh3DU
10c) Substudies have shown similar benefits in the #primary_prevention cohort & in #diabetic vs #nondiabetic cohorts. No safety concerns in any (just confirmed https://t.co/xQziBVuWps ⤵️)
— cardio-met (@cardiomet_CE) November 13, 2023
But what about data on #hsCRP & its response to #bempedoic_acid? Why is that of interest? pic.twitter.com/zNBLtopmDd
11b) This helped advance the concept of #atherosclerosis as–at least in part–an #inflammatory disorder. Though lipid management remains 1st line for #cvPrev, CV events still occur in statin-Rx patients, w/#hsCRP established as an effective marker of residual inflammatory risk.
— cardio-met (@cardiomet_CE) November 13, 2023
12a) Let’s look to another 2o analysis of #CLEAR_OUTCOMES! As we saw in the main trial, #bempedoic acid reduced median #hsCRP by 21.6% and mean #LDLC levels by 21.1% at 6 months, compared to placebo. pic.twitter.com/4NIsW6FAfs
— cardio-met (@cardiomet_CE) November 13, 2023
12c) On other hand, the highest vs lowest baseline #LDLC was less strongly associated with the primary 4pt #MACE endpoint [HR 1.19 (1.04-1.37) and not associated with #CV #mortality [HR 0.90 (0.70-1.17)] or all-cause mortality [HR 0.95 (0.78-1.16)].
— cardio-met (@cardiomet_CE) November 13, 2023
13) Now, these data should not be used to diminish the important role of #LLT for #CV prevention but do suggest that targeting #LDLC alone is unlikely to entirely reduce #ASCVD risk. Addressing inflammatory pathways as part of risk reduction should be further explored.
— cardio-met (@cardiomet_CE) November 13, 2023
15) In sum, the CLEAR Outcomes trial provides a sound rationale for use of #bempedoic acid to reduce major adverse #CV outcomes in patients intolerant to statins, including those at high #inflammatory risk.#AHA23
— cardio-met (@cardiomet_CE) November 13, 2023
16b) (cont)
— cardio-met (@cardiomet_CE) November 13, 2023
🫀 #Bempedoic_acidis a great non-statin alternative for statin intolerant patients with proven efficacy to reduce #CV events
🫀 Nevertheless, even on #LLT, elevated #hsCRP predicts residual risk, offering opportunities to specifically address inflammatory pathways
17b) Unfortunately the correct answer is C. Same applies to niacin—no known help, but used alot, whereas efficacious options such as the other 3 are UNDERutilized in pts with #diabetes.
— cardio-met (@cardiomet_CE) November 13, 2023
18b) It's C. As shown in the #AHA23 data presented by Ridker, #bempedoic_acid can reduce #LDLC levels beyond the benefit of statins, and also reduces #hsCRP levels, indicating a positive impact on inflammation.
— cardio-met (@cardiomet_CE) November 13, 2023
19) So thank you for joining us–@cardiomet_ce LIVE IN THE HOUSE from #AHA23–you feel like you were there, right? That's due to great work by expert author @ErinMichos! Now celebrate by claiming 0.75hr 🆓 CE/#CME at https://t.co/bP4DCcx4xo & then 🖱️ back here & FOLLOW US! pic.twitter.com/E2U2RoRSZZ
— cardio-met (@cardiomet_CE) November 13, 2023