24
Treatment
4.2.6. Lipid Management
COR LOE
Recommendations
Cost Value
Statement:
High
Value
B-NR 6. In patients with CCD, addition of generic ezetimibe to
maximally tolerated statin therapy in appropriately selected
patients is projected to be of high economic value at US
prices.
2a A 7. In patients with CCD who are judged to be at very high
risk (Table 10) and who have an LDL-C level ≥70 mg/
dL (≥1.8 mmol/L), or a non–high-density lipoprotein
cholesterol (HDL-C) level ≥100 mg/dL (≥2.6 mmol/L),
on maximally tolerated statin and ezetimibe, a PCSK9
monoclonal antibody can be beneficial to further reduce
the risk of MACE.*
Cost Value
Statement:
Uncertain
B-NR 8. In patients with CCD who are very high risk, the use
of PCSK9 monoclonal antibodies is projected to be of
uncertain economic value at US prices.
2b B-R 9. In patients with CCD on maximally tolerated statin
therapy with an LDL-C level <100 mg/dL (<2.6 mmol/L)
and a persistent fasting triglyceride level of 150 to 499 mg/
dL (1.7–5.6 mmol/L) after addressing secondary causes,
icosapent ethyl may be considered to further reduce the risk
of MACE and cardiovascular death.
2b B-R 10. In patients with CCD who are not at very high risk and
on maximally tolerated statin therapy with an LDL-C
level ≥70 mg/dL (≥1.8 mmol/L), it may be reasonable to
add ezetimibe to further reduce the risk of MACE.*
2b B-R 11. In patients with CCD on maximally tolerated statin
therapy who have an LDL-C level ≥70 mg/dL (≥1.8
mmol/L), and in whom ezetimibe and PCSK9
monoclonal antibody are deemed insufficient or not
tolerated, it may be reasonable to add bempedoic acid or
inclisiran (in place of PCSK9 monoclonal antibody) to
further reduce LDL-C levels.
3: No
Benefit
B-R 12. In patients with CCD receiving statin therapy, adding
niacin, or fenofibrate or dietary supplements containing
omega-3 fatty acids, are not beneficial in reducing
cardiovascular risk.
* Modified from the 2018 AHA/ACC/Multisociety guideline on the management of blood
cholesterol. Grundy SM, et al. J Am Coll Cardiol. 2019;73:e285-e350.
(cont'd)
