From the Guidelines
Calculating the Atherosclerotic Cardiovascular Disease (ASCVD) score remains a crucial step in managing patients on statin therapy, as it provides essential information for guiding treatment intensity and assessing the need for additional therapies. The ASCVD risk score is a valuable tool for determining a patient's 10-year risk of cardiovascular events, which is still relevant even when a patient is already taking a statin 1. This calculation can help determine if the current statin therapy is appropriate for the patient's risk level or if adjustments are needed. For example, a patient with a very high ASCVD risk score (>20%) might benefit from a high-intensity statin, while someone with a lower score might be appropriately managed on a moderate-intensity statin.
Key Considerations
- The ASCVD score can guide decisions about adding non-statin therapies such as ezetimibe or PCSK9 inhibitors for high-risk patients not achieving adequate LDL reduction with statins alone 1.
- The score also serves as a valuable educational tool to discuss with patients their overall cardiovascular risk and the importance of adhering to their statin therapy and other lifestyle modifications.
- According to the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline, the decision process for treatment in adults aged 40 to 75 years with borderline or intermediate risk for ASCVD begins with estimation of 10-year risk, and the presence of risk-enhancing factors can favor statin therapy 1.
Clinical Implications
- Calculating the ASCVD score can help clinicians make informed decisions about statin therapy intensity and the potential need for additional treatments.
- The score can also be used to monitor changes in cardiovascular risk over time and adjust treatment accordingly.
- By considering the ASCVD score and other risk factors, clinicians can provide personalized care and improve patient outcomes.
From the Research
Calculating ASCVD Score in Patients Taking Statins
- The Atherosclerotic Cardiovascular Disease (ASCVD) score is a useful tool for assessing the risk of cardiovascular events in patients, including those taking statins 2, 3, 4.
- Studies have shown that statins can reduce the risk of ASCVD, but may not be sufficient in decreasing LDL cholesterol levels, posing a significant on-treatment residual risk of major cardiovascular events 2, 4.
- The ASCVD score can help guide statin therapy and inform the use of additional lipid-lowering agents, such as ezetimibe or PCSK9 inhibitors, in patients who require further reduction in LDL cholesterol levels 2, 3, 4, 5, 6.
- Calculating the ASCVD score in patients taking statins can help identify those who may benefit from more intensive lipid-lowering therapy, including the use of PCSK9 inhibitors, which have been shown to reduce cardiovascular events in high-risk patients 4, 5, 6.
Guideline Recommendations
- Current guidelines recommend using the 10-year ASCVD risk to guide statin therapy for primary prevention 3.
- The 2018 Cholesterol Guideline incorporates PCSK9 inhibitors into the treatment algorithm for select secondary prevention patients unable to achieve an LDL-C below 70 mg/dL despite maximally tolerated statin plus ezetimibe 4.
- The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias include the use of PCSK9 inhibitors to very high-risk ASCVD patients who are not achieving treatment goals on a maximum tolerated dose of a statin and ezetimibe 6.
Clinical Implications
- Calculating the ASCVD score in patients taking statins can help clinicians make informed decisions about lipid-lowering therapy and reduce the risk of cardiovascular events 2, 3, 4, 5, 6.
- The use of PCSK9 inhibitors in combination with statins has been shown to reduce cardiovascular events in high-risk patients, but cost-effectiveness is limited to secondary prevention in high-risk patients 4, 5, 6.