In Reply We share the goals of Drs Blum and Stone of optimizing appropriate, evidence-based, cost-effective therapy to prevent cardiovascular events and improve health. However, we disagree about the best way to establish guidelines to get there.
Blum and Stone state that the guidelines indicate that in high-risk patients, nonstatins could be added in “high-risk patients who have a less-than-anticipated response” to statin monotherapy. Yet the guidelines lack clarity in the definition of “less-than-anticipated” and call on prescribers to show appropriate restraint and caution when initiating the new, expensive PCSK-9 inhibitor class. Blum and Stone further note that the guidelines suggest that “clinicians preferentially prescribe drugs that have been shown in RCTs to provide ASCVD risk-reduction benefits that outweigh the potential for adverse effects,” but that those studies are still under way for the PCSK-9 inhibitors.
William H. Shrank, Jane Barlow. New Strategies to Treat High Cholesterol—Reply. JAMA. 2016;315(11):1169–1170. doi:10.1001/jama.2015.18038