In an update to their previous 2007 statement, the AHA and ADA recently presented a review of the current literature and key clinical trials regarding blood pressure and glucose control, cholesterol management, aspirin therapy, and lifestyle modification for primary prevention of CVD in patients with type 2 diabetes. Both the AHA and ADA believed an update was in order due to the major changes that have occurred in the past several years in each of the “ABC” elements of diabetes care (HbA1c, blood pressure, and cholesterol), and because CVD remains the leading cause of death among patients with type 2 diabetes. Read more
Now that the first PCSK9 inhibitors have received FDA approval, the ambiguity of the 2013 ACC/AHA cholesterol-treatment guidelines are again being called into question. Because the new class of LDL-lowering agents are expensive specialty medications, with alirocumab priced at about $14,600 per year, payers are expressing concern that the removal of specific LDL-C targets from the 2013 guidelines will complicate treatment choices and inhibit utilization management tools, such as step therapy and prior authorization, to manage costs. Consequently, they are asking the American College of Cardiology and American Heart Association to return specific LDL targets to the guidelines.
In a recent publication in the European Heart Journal, however, Drs. Jennifer G. Robinson and Neil J. Stone explain the concept of net benefit, which was introduced in the 2013 ACC/AHA guidelines, and how net benefit can be used to identify patients most likely to benefit from statin therapy and which patients may benefit from the addition of a non-statin agent, such as ezetimibe or another LDL-lowering medication. Read more