57
4.2.6. Secondary ASCVD Prevention
COR LOE
Recommendations
Clinical ASCVD at Very High Risk* (cont'd)
2a B-R
7. In adults with clinical ASCVD who are at very high risk
and on maximally tolerated statin therapy with or without
ezetimibe, it is reasonable to add inclisiran
†
in those unable to
tolerate or obtain evolocumab or alirocumab or have a strong
preference for less frequent dosing to achieve an LDL-C goal
<55 mg/dL (1.4 mmol/L) and non–HDL-C <85 mg/dL
(2.2 mmol/L).
Heart Failure With Reduced Ejection Fraction (HFrEF) Due to ASCVD
2b B-R
8. In adults with HFrEF attributable to ischemic heart disease
who have a reasonable life expectancy (3–5 years) and are not
already on a statin because of ASCVD, it may be reasonable
to consider initiation of moderate-intensity statin therapy to
reduce the occurrence of ASCVD events.
* e majority of patients with clinical ASCVD are likely to be at very high risk. Very high risk
includes a history of multiple major ASCVD events (ACS within past 12 months, history of
MI [other than ACS above] history of ischemic stroke, symptomatic PAD) or 1 major ASCVD
event and multiple high-risk conditions (age >65 years of age, coronary artery revascularization,
current smoker, diabetes, history of heart failure, hypertension, LDL-C >100 mg/dL despite
maximally tolerated statin + ezetimibe).
†
Cardiovascular outcomes trials are not completed with inclisiran. It is approved for LDL-C
lowering only and is considered a second-line PCSK9i at this time.
(cont'd)
