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Management of drug-resistant hypercholesterolemia

Hypercholesterolemia is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Statins are used as first-line therapy in most clinical settings (eg, primary and secondary prevention of ASCVD, treatment of familial hypercholesterolemia [FH]). Patients whose low-density lipoprotein cholesterol (LDL-C) remains elevated despite a statin and other therapies that are commonly started (ie, ezetimibe and/or proprotein convertase subtilisin kexin 9 [PCSK9] inhibitors) are said to be drug-resistant. This topic will discuss the evaluation and management of these patients.

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Low-density lipoprotein cholesterol-lowering therapy in the primary prevention of cardiovascular disease

Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk of atherosclerotic cardiovascular disease (CVD) in people without established CVD. This approach to CVD prevention is called primary prevention. The rationale for LDL-C reduction is based upon clinical trial evidence that lowering of LDL-C in patients across a broad range of LDL-C levels reduces a patient's risk of CVD.

CVD in this context refers to fatal or nonfatal myocardial infarction, acute coronary syndrome, sudden cardiac death, coronary artery revascularization, stroke, and peripheral arterial disease.

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