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All Time Low:
Safety and Efficacy of Treating to Very Low LDL
with Non-statin Adjuvants
September 6th, 2019
Aamer Attaar, PharmD
PGY-2 Internal Medicine Pharmacy Resident
Ascension Seton
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Table of Contents
Presentation Slides…………………………………………………………..pages 3 to 13
Appendix A: Abbreviations………………………………………………………..page 14
Appendix B: Guideline Definitions……………………………………………..page 15
Appendix C: ODYSSEY LONG TERM Adverse Events Table………….page 16
Appendix D: OSLER Adverse Events Table………………………………….page 17
Appendix E: REDUCE-IT Efficacy Endpoints………………………………..page 18
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Appendix A: Abbreviations
ACC: American College of Cardiology
ACS: Acute coronary syndrome
AF: Atrial Fibrillation
AHA: American Heart Association
ASA: Aspirin
ASCVD: Atherosclerotic cardiovascular disease
CAD: Coronary artery disease
CETP: Cholesteryl ester transfer protein
CKD: Chronic kidney disease
CV: Cardiovascular
CVA: Cerebrovascular accident
DAPT: Dual antiplatelet therapy
DM: Diabetes mellitus
HDL: High-density lipoprotein
HTN: Hypertension
LDL: Low-density lipoprotein
MACE: Major adverse cardiovascular events
MDD: Major depressive disorder
MI: Myocardial infarction
NSTEMI: Non-ST elevation myocardial infarction
PCI: Percutaneous coronary intervention
PCSK9: Protein convertase subtilisin/kexin type 9
TC: Total cholesterol
TG: Triglycerides
TIA: Transient ischemic attack
UA: Unstable angina
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Appendix B: Guideline Definitions
Metabolic syndrome – 3 out of 5 of the following characteristics:
• Increased waist circumference (> 40 inches in men; > 35 inches in women)
• Elevated triglycerides (> 150 mg/dL)
• Elevated blood pressure (> 130/> 85 mmHg)
• Elevated glucose (fasting > 110 mg/dL)
• Low HDL (< 40 mg/dL in men; < 50 mg/dL in women)
High-risk (1 major ASCVD event and other high-risk conditions or a history of multiple major
ASCVD events):
• Major ASCVD event:
o Recent ACS (within past 12 months)
o History of MI or ischemic stroke
o Symptomatic peripheral arterial disease
• High-risk conditions:
o Age > 65
o Heterozygous familial hypercholesterolemia
o History of prior CABG or PCI outside of a major ASCVD event
o Diabetes mellitus
o Hypertension
o CKD (eGFR 15-59 mL/min/1.73m2)
o Current smoker
o Persistently elevated LDL > 100 mg/dL despite maximally tolerated statin and
ezetimibe therapy
o History of congestive heart failure
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Appendix C: Robinson JG, et al. N Engl J Med. 2015;372:1489-99.
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Appendix D: Sabatine MS, et al. N Engl J Med. 2015;372:1500-9.
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Appendix E: Bhatt DL, et al. N Engl J Med. 2019;380:11-22.