PMID- 28623740
OWN - NLM
STAT- MEDLINE
DCOM- 20180705
LR  - 20211204
IS  - 1879-1484 (Electronic)
IS  - 0021-9150 (Linking)
VI  - 263
DP  - 2017 Aug
TI  - Detection of atherosclerotic cardiovascular disease influences the perceived need 
      for aggressive lipid management.
PG  - 112-118
LID - S0021-9150(17)30255-1 [pii]
LID - 10.1016/j.atherosclerosis.2017.06.006 [doi]
AB  - BACKGROUND AND AIMS: Overt atherosclerotic cardiovascular disease (ASCVD) 
      warrants aggressive lipid lowering. Imaging for ambiguous symptoms suggesting 
      ischemia or for clarification of CV risk in asymptomatic individuals often 
      uncovers previously unknown ASCVD. Guidelines do not provide clear 
      recommendations for aggressive lipid lowering in such cases. We explored 
      physicians' perception, as influenced by tests that detect ASCVD, regarding 
      appropriateness of getting to lipid goals and for theoretically accessing 
      proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i). METHODS: A 
      questionnaire was developed including cases of low to high CV risk, chronic 
      kidney disease (CKD) or type 2 diabetes mellitus (T2DM). Each case was considered 
      with or without angina symptoms and, in turn, whether testing identified 
      previously unknown advanced, early/subclinical or no ASCVD. Synthesis of 
      responses was facilitated by using a scale for perceived appropriateness from 1 
      (lowest) to 9 (highest). RESULTS: Getting to goal and, if not achieved by statins 
      and/or ezetimibe, accessing PCSK9i was considered appropriate in patients with 
      T2DM with preclinical or advanced ASCVD, patients with moderate or high CV risk 
      and advanced ASCVD, patients with CKD or low CV risk with angina symptoms and 
      advanced ASCVD. For most of the remaining cases adding PCSK9i was considered only 
      possibly appropriate. CONCLUSIONS: Physicians' perception of appropriateness for 
      achieving lipid goals, including access to PCSK9i, is markedly influenced by 
      detection of previously unknown ASCVD. Since these commonly encountered scenarios 
      do not clearly meet current indications for PCSK9i, our data identify pressing 
      areas requiring further research.
CI  - Copyright (c) 2017 The Authors. Published by Elsevier B.V. All rights reserved.
FAU - Mancini, G B John
AU  - Mancini GBJ
AD  - University of British Columbia, Vancouver, British Columbia, Canada. Electronic 
      address: mancini@mail.ubc.ca.
FAU - Gupta, Milan
AU  - Gupta M
AD  - McMaster University, Hamilton, Ontario, Canada; Canadian Collaborative Research 
      Network, Brampton, Ontario, Canada.
FAU - Tsigoulis, Michelle
AU  - Tsigoulis M
AD  - Canadian Collaborative Research Network, Brampton, Ontario, Canada.
FAU - Cannon, Christopher P
AU  - Cannon CP
AD  - Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
FAU - Genest, Jacques
AU  - Genest J
AD  - McGill, Montreal, Quebec, Canada.
FAU - Ray, Kausik K
AU  - Ray KK
AD  - Imperial Centre for Cardiovascular Disease Prevention, Department of Public 
      Health and Primary Care at Imperial College London and Imperial College NHS 
      Trust, London, England, United Kingdom.
FAU - Santos, Raul D
AU  - Santos RD
AD  - Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao 
      Paulo, Brazil.
FAU - Watts, Gerald F
AU  - Watts GF
AD  - Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of 
      Medicine, Faculty of Health and Medical Sciences, University of Western 
      Australia, Perth, Western Australia, Australia.
FAU - Raggi, Paolo
AU  - Raggi P
AD  - Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, 
      Canada.
LA  - eng
PT  - Journal Article
DEP - 20170603
PL  - Ireland
TA  - Atherosclerosis
JT  - Atherosclerosis
JID - 0242543
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Lipids)
RN  - 0 (PCSK9 Inhibitors)
RN  - EC 3.4.21.- (PCSK9 protein, human)
RN  - EOR26LQQ24 (Ezetimibe)
SB  - IM
MH  - Aged
MH  - Angina, Unstable/complications
MH  - Atherosclerosis/blood/*diagnosis/drug therapy
MH  - Cardiologists
MH  - Cardiology/*standards
MH  - Cardiovascular Diseases/blood/*diagnosis/drug therapy
MH  - Diabetes Mellitus, Type 2/complications
MH  - Ezetimibe/therapeutic use
MH  - Female
MH  - Humans
MH  - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Lipids/*blood
MH  - Male
MH  - Middle Aged
MH  - PCSK9 Inhibitors
MH  - Practice Patterns, Physicians'
MH  - Renal Insufficiency, Chronic/complications
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Surveys and Questionnaires
OTO - NOTNLM
OT  - Angina pectoris
OT  - Atherosclerotic cardiovascular disease
OT  - Cardiovascular risk
OT  - Low density lipoprotein-cholesterol
OT  - Primary prevention
OT  - Proprotein convertase subtilisin/kexin type 9 inhibitors
EDAT- 2017/06/18 06:00
MHDA- 2018/07/06 06:00
CRDT- 2017/06/18 06:00
PHST- 2017/04/28 00:00 [received]
PHST- 2017/05/21 00:00 [revised]
PHST- 2017/06/02 00:00 [accepted]
PHST- 2017/06/18 06:00 [pubmed]
PHST- 2018/07/06 06:00 [medline]
PHST- 2017/06/18 06:00 [entrez]
AID - S0021-9150(17)30255-1 [pii]
AID - 10.1016/j.atherosclerosis.2017.06.006 [doi]
PST - ppublish
SO  - Atherosclerosis. 2017 Aug;263:112-118. doi: 
      10.1016/j.atherosclerosis.2017.06.006. Epub 2017 Jun 3.