1b) The new #gduidelines can be found at 🔓 https://t.co/06ldtc4m2A along with an infographic 🔓https://t.co/4JwRfqXEEw
— cardio-met (@cardiomet_CE) July 19, 2022
3) There continues to be 🙅♂️ debate that #LDL_C is a primary cause of #CVD, the leading cause of death throughout the 🌎. Unfortunately, #CVD ☠️ ⬆️ from 2010 to 2019.
— cardio-met (@cardiomet_CE) July 19, 2022
See 🔓https://t.co/PreE7xS5gF pic.twitter.com/jtWmlJpqxr
5) Despite being well tolerated by most patients, #statin #intolerance (or perceived intolerance) is commonly reported by patients and is a major barrier to their optimal use. But how should #statin intolerance be defined in the modern era?
— cardio-met (@cardiomet_CE) July 19, 2022
7) Before introducing the new definition, let’s revisit some basics.
— cardio-met (@cardiomet_CE) July 19, 2022
Patients generally recognize the benefits of #statin therapy but are also very concerned with statin-associated side effects.
🔓https://t.co/SsxawCnmxQ pic.twitter.com/KocS2Kbz4N
9) Confirmation of 💪-related symptoms associated with #statins is challenging as creatine kinase (#CK) levels are often normal.
— cardio-met (@cardiomet_CE) July 19, 2022
Less commonly, #statins are associated with #myopathy, and very rarely, #rhabdomyolysis, both of which are associated with ⬆️⬆️⬆️CK levels. pic.twitter.com/I3G0EsN2F5
11) The BIG question is whether #statin #intolerance is real🤷♀️. Debate surrounding this has intensified as recent trials suggest #statin intolerance may at least partially be due to the #nocebo effect. pic.twitter.com/kSr9q7hBDp
— cardio-met (@cardiomet_CE) July 19, 2022
13) The #SAMSON trial suggests as much as 90% of reported #statin associated side effects are due to the #nocebo effect🤯. Patterns of symptom intensity & timing of symptom onset or offset were identical between placebo and atorvastatin 20mg/d.
— cardio-met (@cardiomet_CE) July 19, 2022
🔓https://t.co/U9LWrHswVs pic.twitter.com/AZk7cPjMSr
15) So, how common is #statin #intolerance, really?
— cardio-met (@cardiomet_CE) July 19, 2022
Based on the available data, the incidence of #statin intolerance (partial or complete) is estimated to be between 5% and 30%.
Complete #statin intolerance, however, is RARE! (<5%) pic.twitter.com/ru75EPx85P
17) Knowledge check time! 🧐
— cardio-met (@cardiomet_CE) July 19, 2022
Why do most patients stop taking their #statin?
19) WELCOME BACK! You are learning about the new @nationallipid #guidelines for the management of #hyperlipidemia in pts with #statin #intolerance from guidelines author @DaveDixonPharmD. Learn more about lipid management and earn more 🆓CE/#CME at https://t.co/gMHi5FYTek.
— cardio-met (@cardiomet_CE) July 20, 2022
21) 📢📢📢Whether #statin #intolerance is real or perceived, it MUST be managed.
— cardio-met (@cardiomet_CE) July 20, 2022
✅Let’s start with identifying modifiable #riskfactors associated with #statin intolerance. Identifying and addressing these may help in some cases. pic.twitter.com/WXSAU0uRhV
23) ☝️Time for a reminder that #lifestyle therapies – 🥦 🏃♀️🚭 – should ALWAYS be a part of an effective #ASCVD risk reduction strategy pic.twitter.com/1WpbAmk3At
— cardio-met (@cardiomet_CE) July 20, 2022
25) Also, in high-risk or very-high-risk patients, it is unnecessary to attempt unconventional #statin dosing strategies that often delay the use of non-statin therapies.
— cardio-met (@cardiomet_CE) July 20, 2022
✅Limiting the time exposure to elevated #LDL_C is critical!
🔓 https://t.co/3EXphYlIeM pic.twitter.com/uujyJ1G5UW
27a) The #PCSK9 mAbs, #alirocumab & #evolocumab, ⬇️ #LDL-C 50-60% when combined with #statin therapy.
— cardio-met (@cardiomet_CE) July 20, 2022
✅#RCT evidence from FOURIER & ODYSSEY support their use, but it is unknown whether #PCSK9 mAb monotherapy ⬇️ #ASCVD risk
(see @PamTaubMD's program at https://t.co/1WTBo2NPhT)
28) 🆕 #Inclisiran is a small interfering RNA that ⬇️ #PCSK9 synthesis via gene silencing🤯 and ⬇️ #LDL_C approximately 50%-60%
— cardio-met (@cardiomet_CE) July 20, 2022
✅It must be administered by a 👩⚕️👨⚕️ and the maintenance dose is given only every 6 months! pic.twitter.com/VOpUfX7yKK
30) Bile acid sequestrants ⬇️ #LDL_C 13-25% but also ⬆️ TG levels 5-20%. Data are quite limited regarding #ASCVD risk reduction. Tolerability and 💊-💊 interactions are also notable limitations of use. pic.twitter.com/8HnHAbLAw5
— cardio-met (@cardiomet_CE) July 20, 2022
32) #Fenofibrate and #gemfibrozil ⬇️ #TG levels 25-55% & variably ⬇️ #LDL_C by 5-20%.
— cardio-met (@cardiomet_CE) July 20, 2022
Gemfibrozil monotherapy reduced #ASCVD events in the VA-HIT and HHS trials, while fenofibrate trials have been less successful.
34) #O3FA 🐟 are primarily indicated to treat severe #hypertriglyceridemia.
— cardio-met (@cardiomet_CE) July 20, 2022
☝️Only #icosapent_ethyl 4g/d has been shown to ⬇️#ASCVD risk (REDUCE-IT). #LDL_C ⬆️in both groups but less so with icosapent ethyl, while TG levels were ⬇️by ~20%.
🔓 https://t.co/qJeKi87SaP pic.twitter.com/niskbwQblO
36) #Nicotinic_acid was long used due to its favorable effects on #HDL_C, #LDL_C, and #TG.
— cardio-met (@cardiomet_CE) July 20, 2022
☝️However, two negative #RCTs (https://t.co/TFFCGTVoUw and https://t.co/EpLwUi00LR ) and its poor tolerability🥵 have largely put nicotinic acid largely out of business. pic.twitter.com/2ecMD7HVYQ
38) One last knowledge check!🤓
— cardio-met (@cardiomet_CE) July 20, 2022
Which non-statin has been shown to ⬇️ASCVD risk when combined with statin therapy?
40) And that's it! You just earned 0.5h CE/#CME! Go claim your certificate at https://t.co/fC7MS6JsfF and FOLLOW US here at @cardiomet_ce for more expert-led #accredited education! I am @DaveDixonPharmD. Thanks for joining us!@MedTweetorials #Cardiotwitter #MedTwitter
— cardio-met (@cardiomet_CE) July 20, 2022