What is the treatment of choice for a 56-year-old woman with an atherosclerotic cardiovascular risk estimator (ASCVE) score of 8.2%?

From the Guidelines

For a 56-year-old woman with an ASCVE score of 8.2%, the treatment of choice is moderate-intensity statin therapy. This recommendation is based on the 2019 guidelines from the American College of Cardiology and American Heart Association, as outlined in the study by 1, which emphasizes the importance of statin therapy in primary prevention of atherosclerotic cardiovascular disease (ASCVD) for individuals with a 10-year risk of 7.5% or higher. The patient's ASCVE score of 8.2% falls into the intermediate risk category, and according to the guidelines, statin therapy is recommended for individuals in this category, especially when considering risk-enhancing factors such as family history of premature ASCVD, LDL-C levels, and others as mentioned in 1.

The treatment should include medications such as atorvastatin 10-20 mg daily, rosuvastatin 5-10 mg daily, or simvastatin 20-40 mg daily, initiated alongside lifestyle modifications including a heart-healthy diet, regular physical activity, smoking cessation if applicable, and weight management. As noted in 1, statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels or those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion.

Key points to consider in the management of this patient include:

• Initiation of moderate-intensity statin therapy to reduce LDL cholesterol levels and subsequently the risk of ASCVD events.
• Lifestyle modifications to complement statin therapy, including dietary changes, increased physical activity, and smoking cessation.
• Regular follow-up to monitor the response to therapy and adjust the treatment plan as necessary, with follow-up lipid panels at 4-12 weeks after initiating therapy and annual monitoring thereafter.
• Consideration of additional therapies, such as aspirin, if the patient has other risk factors, weighing the benefits against the potential risks, such as bleeding.

Overall, the management of a 56-year-old woman with an ASCVE score of 8.2% should focus on reducing her risk of experiencing a cardiovascular event through a combination of statin therapy and lifestyle modifications, as supported by the guidelines and evidence from studies like 1, 1, and 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Treatment of Choice for Atherosclerotic Cardiovascular Risk

The treatment of choice for a 56-year-old woman with an atherosclerotic cardiovascular risk estimator (ASCVE) score of 8.2% depends on various factors, including her overall health, medical history, and lifestyle.

• According to the study 2, statins are recommended as a first-line therapy for the primary and secondary prevention of ASCVD.
• The study 3 suggests that PCSK9 inhibitors, such as evolocumab and alirocumab, can be used in combination with statins to reduce LDL-C levels and ASCVD risk in high-risk patients.
• The American Society for Preventive Cardiology clinical practice statement 4 recommends assessing baseline ASCVD risk using global risk scores and considering additional "risk enhancing" factors to inform treatment decisions.

Pharmacological Strategies

• The study 2 recommends the use of ezetimibe, a cholesterol absorption inhibitor, in addition to statin therapy, to achieve additional LDL cholesterol reduction and reduce ASCVD risk.
• The study 5 discusses the potential of targeting angiopoietin-like 3 (ANGPTL3) as a novel approach for the treatment of dyslipidaemia and atherosclerosis.
• The study 3 outlines the clinical benefits of PCSK9 inhibitors, including their ability to reduce LDL-C levels by 50-60% above that achieved by statin therapy alone.

Risk Assessment and Management

• The study 4 emphasizes the importance of accurate ASCVD risk assessment and the use of global risk scores, such as the ASCVE score, to inform treatment decisions.
• The study 6 highlights the significance of metabolic syndrome and its components in estimating ASCVD risk and the need for lifestyle modifications and treatment of hypertension, diabetes, and dyslipidaemia to reduce cardiovascular risk.
• The treatment approach should be individualized based on the patient's specific risk factors, medical history, and lifestyle, and may involve a combination of pharmacological and lifestyle interventions 2, 3, 4.