Statin Use With the ATP III Guidelines Compared to the 2013 ACC/AHA Guidelines in HIV Primary Care Patients

2016 ◽  
Vol 30 (1) ◽  
pp. 64-69 ◽  
Author(s):  
Pansy Elsamadisi ◽  
Agnes Cha ◽  
Elise Kim ◽  
Safia Latif
Keyword(s):  
Statin Therapy ◽  
Retrospective Chart Review ◽  
Population Based ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Laboratory Test Results ◽  
Hiv Primary Care ◽  
Cholesterol Guidelines ◽  
Level Of Agreement ◽  
Statin Use

Background: The 2013 Cholesterol Guidelines include a new atherosclerotic cardiovascular disease (ASCVD) risk calculator that determines the 10-year risk of coronary heart disease and/or stroke. The applicability of this calculator and its predecessor, the Framingham risk score (FRS) in Adult Treatment Panel (ATP) III, has been limited in patients with HIV. The objective of this study was to compare the risk scores of ASCVD and FRS in the initiation of statin therapy in patients with HIV. Methods: We conducted a retrospective chart review of patients with HIV on statin therapy from October 1, 2013, to April 1, 2014. Data collection included patient demographics, pertinent laboratory test results, and medication list. The primary end point evaluated the level of agreement between the guidelines. Results: Of 155 patients who met the inclusion criteria, 116 were treated similarly with both guidelines. This showed a moderate level of agreement ( P < .001). Forty-eight of 86 patients requiring statins were placed on the correct intensity statin using the 2013 guidelines. Regardless of which guideline, a majority of patients required statin therapy. Conclusion: A moderate agreement was found between both guidelines in terms of statin use when applied to an HIV patient population. Based on the 2013 guidelines and taking into account drug interactions with antiretrovirals, 44.2% of the patients were treated with an incorrect statin intensity.

scholarly journals Lower is better: ezetimibe and PCSK9 inhibition join the mainstream of lipid‑lowering therapy

2016 ◽  
Vol 7 (1) ◽  
pp. 17-25
Author(s):  
Cezary Wójcik
Keyword(s):  
Statin Therapy ◽  
Heart Association ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Level Of Evidence ◽  
Cholesterol Guidelines ◽  
Pcsk9 Inhibition ◽  
Current Guidelines

The focus of 2013 cholesterol guidelines to prevent atherosclerotic cardiovascular disease (ASCVD) released by American College of Cardiology (ACC) and American Heart Association (AHA) is the administration of high intensity statin therapy to specific four groups of patients, which were found to benefit the most from such therapy. They no longer promote achieving specific LDL-C goals with a combination therapy involving statins and other drugs, as advocated by the former ATP-III guidelines as well as current guidelines of European Atherosclerosis Society, International Atherosclerosis Society or National Lipid Association. Such approach has been dictated by the strict reliance on randomized controlled trials as the only acceptable level of evidence. However, since publication of the 2013 ACC/AHA guidelines, cardiovascular benefits of ezetimibe added to statin therapy have been established. Moreover, the advent of PCSK9 inhibitors, providing a powerful supplement and/or alternative to statin therapy, further complicates the therapeutic horizon in dyslipdiemias. It is very likely that a new set of ACC/AHA guidelines will be published in 2016, with a return of specific LDL-C and Non-HDL-C goals of therapy as well as integration of drugs other than statins. As the treatment of dyslipidemias becomes more complex, the need for the subspecialty of clinical lipidology to be officially recognized becomes more evident.

Abstract 05: Assessing Population Impact of Statin Treatment for Primary Prevention of Atherosclerotic Cardiovascular Diseases in US

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Quanhe Yang ◽  
Yuna Zhong ◽  
Catheen Gillespie ◽  
Robert Merritt ◽  
Barbara Bowman ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Adverse Effects ◽  
Randomized Clinical Trials ◽  
Statin Treatment ◽  
Population Based ◽  
Number Needed To Treat ◽  
Atherosclerotic Cardiovascular Disease ◽  
Population Impact ◽  
New Guidelines ◽  
Statin Use

Introduction: American College of Cardiology/American Heart Association (ACC/AHA) new cholesterol treatment guidelines recommend consideration of statin treatment for a larger proportion of population for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). It is important to assess the population impact of statin treatment under these new guidelines. Hypothesis: We assessed the hypothesis that increased statin use for the primary prevention of ASCVD might be accompanied by adverse effects among population. Methods: We used 2010 US Census, Multiple Cause Mortality, Third National Health and Nutrition Examination Survey Linked Mortality File (NHANES III 1988-2006, n=7095) and NHANES 2005-2010 (n=3178) participants 40-75 years of age to estimate prevalence of statin use, annual ASCVD deaths prevented and excess adverse effects by age, sex, and race/ethnicity if everyone followed updated guidelines. Results: Among 33.0 million adults aged 40-75 years meeting new guidelines for primary prevention of ASCVD (12.4 million with diabetes and 20.6 without diabetes but with a predicted 10-year ASCVD risk ≥7.5% and 70 ≤ low-density lipoprotein (LDL) ≤189 mg/dL), 26.9% (8.8 million) were on statins, indicating an additional 24.2 million potentially eligible for statin treatment (7.7 million with diabetes and 16.5 million without). Among the 7.7 million with diabetes, assuming 100% statin use, expected annual ASCVD deaths prevented were 2,514 (95% CI 592-4,142) and number-needed-to-treat (NNT) was 3,063 (1,860-13,017). The additional cases of myopathy based on estimates from randomized clinical trials (RCT) was 482 (0-2239) and number-needed-to-harm (NNH) was 15,992 (3,440-∞), and was 11,801 (9,251-14,916) and NNH 653 (516-833) based on estimates from population-based studies. Among 16.5 million without diabetes, ASCVD deaths prevented were 5,425 (1,276-8,935) with NNT 3,039 (1,845-12,914). The additional diabetes cases were 16,406 (4,922-26,250) with NNH 1,005 (628-3,349). Additional cases of myopathy was 1,030 (0-4,791) with NNH 15,996 3,441-∞) based on RCT estimates, and 24,302 (19,363-30,292) with NNH 678 (544-851) for population-based studies. ASCVD deaths prevented increased with age and >70% of ASCVD deaths prevented would occur among adults aged ≥60 years. Conclusions: Under ACC/AHA new guidelines for primary prevention of ASCVD by statin, assuming all those eligible took a statin, up to 12.6% of annual ASCVD deaths could be prevented, but could be accompanied by additional cases of diabetes and myopathy.

scholarly journals Statins: Practical Considerations – A Review

2014 ◽  
Vol 9 (2) ◽  
pp. 71
Author(s):  
Kazeen Abdullah ◽  
Anand Rohatgi ◽  
◽  
Keyword(s):  
Treatment Approach ◽  
Lipid Lowering ◽  
Risk Scores ◽  
Fixed Dose ◽  
Individual Risk ◽  
Statin Intolerance ◽  
Increased Risk ◽  
Dramatic Shift ◽  
Cholesterol Guidelines ◽  
Statin Use

Statins are currently the most efficacious and widely prescribed lipid-lowering medications. The 2013 ACC/AHA cholesterol guidelines provide a dramatic shift in treatment approach with a focus on fixed-dose statins matched to individual risk scores. Statin intolerance is not uncommon and can be challenging to diagnose and manage; however, several therapeutic strategies have been successful in achieving statin tolerance. Statin use is also associated with liver enzyme elevations and increased risk of incident diabetes, but studies show these individuals benefit from statins. Several guidelines exist and statin use is expected to increase with the new cholesterol guidelines bringing along new challenges for prescribers. This review article will provide practical considerations for statin use and management of statin intolerance.

Abstract 16936: Implications of the 2013 ACC/AHA Cholesterol Guidelines for Adults in Contemporary Cardiovascular Practice: Insights from the NCDR® PINNACLE Registry®

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas Maddox ◽  
William Borden ◽  
Fengming Tang ◽  
Salim Virani ◽  
William Oetgen ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Current Practice ◽  
Risk Group ◽  
National Registry ◽  
Lipid Lowering ◽  
Fixed Dose ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Cholesterol Guidelines ◽  
Testing Patterns

Background: In a significant update, the 2013 ACC/AHA cholesterol guidelines recommend fixed-dose statin therapy for those at risk and do not recommend non-statin therapies or treatment to target LDL-C levels, limiting the need for repeated LDL-C testing. We examined the implications of these updated guidelines on current lipid treatment and testing patterns in a national registry of cardiology practices. Methods: Using NCDR® PINNACLE Registry® data from 2008 to 2012, we assessed current practice patterns as a function of the 2013 cholesterol guidelines. Lipid-lowering therapies and LDL-C testing patterns by patient risk group (atherosclerotic cardiovascular disease (ASCVD), diabetes, off-treatment LDL-C ≥190mg/dL, or an estimated 10-year ASCVD risk ≥7.5%) were described. Results: Among a cohort of 1,174,545 patients, 1,129,205 (96.1%) were statin-eligible (91.2% ASCVD, 6.6% diabetes, 0.3% off-treatment LDL-C ≥190mg/dL, 1.9% estimated 10-year ASCVD risk ≥7.5%). 377,311 (32.4%) patients were not receiving statin therapy and 259,143 (22.6%) were receiving non-statin therapies. 20.8% patients had 2 or more LDL-C assessments during the study period, and 7.0% had more than 4 assessments. Conclusions: In U.S. cardiovascular practices, 32.4% of statin-eligible patients, as defined by the 2013 ACC/AHA cholesterol guidelines, were not currently receiving them. In addition, 22.6% were receiving non-statin lipid-lowering therapies and 20.8% had repeated LDL-C testing. Achieving concordance with the new cholesterol guidelines would result in significant increases in statin use, as well as significant reductions in non-statin therapies and laboratory testing.

scholarly journals Factors Associated with Disparities in Appropriate Statin Therapy in an Outpatient Inner City Population

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 361
Author(s):  
Giselle Alexandra Suero-Abreu ◽  
Aris Karatasakis ◽  
Sana Rashid ◽  
Maciej Tysarowski ◽  
Analise Douglas ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Medical Center ◽  
Statin Treatment ◽  
Population Based ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Black Race ◽  
Black Patients ◽  
Hispanic Patients ◽  
Ascvd Risk

Lipid-lowering therapies are essential for the primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). The aim of this study is to identify discrepancies between cholesterol management guidelines and current practice with a focus on statin treatment in an underserved population based in a large single urban medical center. Among 1042 reviewed records, we identified 464 statin-eligible patients. Age was 61.0 ± 10.4 years and 53.9% were female. Most patients were black (47.2%), followed by Hispanic (45.7%) and white (5.0%). In total, 82.1% of patients were prescribed a statin. An appropriate statin was not prescribed in 32.4% of statin-eligible patients who qualified based only on a 10-year ASCVD risk of ≥7.5%. After adjustment for gender and health insurance status, appropriate statin treatment was independently associated with age >55 years (OR = 4.59 (95% CI 1.09–16.66), p = 0.026), hypertension (OR = 2.38 (95% CI 1.29–4.38), p = 0.005) and chronic kidney disease (OR = 3.95 (95% CI 1.42–14.30), p = 0.017). Factors independently associated with statin undertreatment were black race (OR = 0.42 (95% CI 0.23–0.77), p = 0.005) and statin-eligibility based solely on an elevated 10-year ASCVD risk (OR = 0.14 (95% CI 0.07–0.25), p < 0.001). Hispanic patients were more likely to be on appropriate statin therapy when compared to black patients (86.8% vs. 77.2%). Statin underprescription is seen in approximately one out of five eligible patients and is independently associated with black race, younger age, fewer comorbidities and eligibility via 10-year ASCVD risk only. Hispanic patients are more likely to be on appropriate statin therapy compared to black patients.

Abstract 10426: One Year Impact of the 2013 Cholesterol Guidelines on Patterns of Lipid Lowering Treatment

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Josephine N Tran ◽  
Tzu Chun Kao ◽  
Toros Caglar ◽  
Karen M Stockl ◽  
Heidi C Lew ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Arterial Disease ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Dose ◽  
Atherosclerotic Cardiovascular Disease ◽  
Patients With Diabetes ◽  
Cholesterol Guidelines ◽  
One Year

Background: In 2013, national organizations issued new cholesterol guidelines to emphasize evidence-based treatment with moderate- to high-dose statins for patients at high risk for atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease, stroke, and peripheral arterial disease. Whether these new guidelines have influenced patterns of treatment one year after their dissemination is unknown. Methods: Using pharmacy and medical claims from a large U.S. health insurance organization, we identified 610,535 adult patients with ASCVD (n=301,440) or diabetes mellitus (n=309,095) and examined statin treatment rates before and one year after the new cholesterol guidelines. Among patients receiving statins post-guidelines, we also evaluated whether patients were treated with guideline-recommended intensity of statin therapy. A standardized difference (SD) of at least 10% was required to declare the effect size meaningful. Results: Overall, there was no change in statin treatment rates for patients with ASCVD (48.0% before guidelines vs. 47.3% after, SD [1.4]) or diabetes (50% vs. 51.5% after, SD [2.4]). Statin initiation rates among patients not on statins pre-guidelines were 10.1% in patients with ASCVD and 14.3% in patients with diabetes, and these gains were offset by 13.0% and 12.2% statin discontinuation rates among ASCVD and diabetes patients, respectively. Among patients taking statins one year post-guidelines, 80% of patients with ASCVD and < 75 years of age were not on guideline-recommended high-intensity statin therapy, whereas >75% of patients with ASCVD and >75 years of age or patients with diabetes were on moderate- or high-intensity statin treatment. Conclusion: One year after dissemination of the new 2013 cholesterol guidelines, overall treatment rates with statins among patients with ASCVD and diabetes have not changed appreciably, and many patients remain either untreated or under-treated. Character Count: 1683

Abstract 18914: Comparison of Statin Eligibility Using the Pooled Cohort Equations, ATP-III Framingham and Reynolds Risk Scores Among Adults Who Experienced ASCVD Events: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tamar Polonsky ◽  
David Couper ◽  
Amy Yang ◽  
Philip Greenland ◽  
Salim Virani ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Lower Risk ◽  
Primary Outcome ◽  
Blood Cholesterol ◽  
Risk Scores ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk ◽  
Estimated Risk ◽  
Ascvd Risk ◽  
Statin Use

Background: The 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol recommended initiating statin therapy when an individual’s 10-year estimated ASCVD risk ≥7.5% We sought to determine whether adults who eventually experienced ASCVD events were more likely to be identified as having ≥7.5% risk using the ACC/AHA’s Pooled Cohort Equations (PCE) compared to the ATP III-Framingham (FRS) and Reynolds risk scores (RRS). Methods: We used data from the biracial Atherosclerosis Risk in Communities Study (ARIC) visit 4 (1996-1998) because hsCRP was measured at this exam. We excluded participants with an ASCVD event prior to visit 4, diabetes, statin use at visit 4, age>74, LDL-C >190 mg/dl, or missing data. Published models for the PCE, ATP III-FRS, and RRS estimated risk. We defined statin eligibility as an estimated 10-year risk ≥7.5% for the PCE and RRS, and ≥10% for the ATP III-FRS. The primary outcome for each score was based on the outcomes originally used to derive the scores: ATP III-FRS (MI or CHD death), PCE (MI, CHD death, stroke) and RRS (MI, CHD death, stroke and revascularization). Results: Using the PCE, 2592 participants had an estimated risk ≥7.5% and 2760 <7.5%. The median age among those with estimated risk ≥7.5% was 66; 19% were black and 35% were women. Over a median of 11 years 304 CHD events, 201 strokes and 432 revascularizations occurred. With all 3 risk scores >80% of men who experienced events had an estimated risk ≥7.5% (see Table). In contrast, a much smaller proportion of women who experienced events had an estimated risk ≥7.5%, although the PCE yielded the highest proportion (52%). Conclusions: A cutoff of ≥7.5% 10-year ASCVD risk identified the majority of male participants in ARIC who experienced subsequent ASCVD events regardless of the risk score used. Substantially fewer women who experienced events were identified. Lower risk cutoffs or additional markers of ASCVD risk may be required when making decisions about statin therapy for women.

scholarly journals Heterogeneity in statin responses explained by variation in the human gut microbiome

2021 ◽  
Author(s):  
Tomasz Wilmanski ◽  
Sergey A. Kornilov ◽  
Christian Diener ◽  
Mathew Conomos ◽  
Jennifer C. Lovejoy ◽  
...  
Keyword(s):  
Side Effects ◽  
Statin Therapy ◽  
Gut Microbiome ◽  
Metabolic Health ◽  
Atherosclerotic Cardiovascular Disease ◽  
Microbiome Composition ◽  
Increased Risk ◽  
Statin Use ◽  
Target Effects ◽  
Health Parameters

AbstractStatins remain one of the most prescribed medications worldwide. While effective in decreasing atherosclerotic cardiovascular disease risk, statin use is associated with several side effects for a subset of patients, including disrupted metabolic control and increased risk of type II diabetes. We investigated the potential role of the gut microbiome in modifying patient response to statin therapy. In a cohort of >1840 individuals, we find that the hydrolyzed substrate for 3-hydroxy-3-methylglutarate-CoA (HMG-CoA) reductase, HMG, may serve as a reliable marker for statin on-target effects. Through exploring gut microbiome associations between blood-derived measures of statin effectiveness and metabolic health parameters among statin users and non-users, we find that heterogeneity in statin response is associated with variation in the gut microbiome. A Bacteroides rich, α-diversity depleted, microbiome composition corresponds to the strongest statin on-target response, but also greatest disruption to glucose homeostasis, indicating lower treatment doses and/or complementary therapies may be beneficial in those individuals. Our findings suggest a potential path towards personalizing statin treatment through gut microbiome monitoring.Between 25% - 30% of older adults across the United States and Europe take statins regularly for the purpose of treating or preventing atherosclerotic cardiovascular disease (ACVD), making statins one of the most prescribed medications in the developed world 1,2. While statins have proven to be highly effective in decreasing ACVD-associated mortality, considerable heterogeneity exists in terms of efficacy (i.e., lowering low density lipoprotein (LDL) cholesterol) 3. Furthermore, statin use can give rise to a number of side effects in a subset of patients, including myopathy, disrupted glucose control, and increased risk of developing type II diabetes (T2D) 4–8. Several guidelines exist for which at-risk populations should be prescribed statins and at what intensity 9. However, despite considerable progress in identifying pharmacological 10 and genetic factors 11 contributing to heterogeneity in statin response, personalized approaches to statin therapy remain limited. Many times, treatment decisions are made through trial and error between the clinician and patient to obtain an optimal tolerable dose 12. Avoiding this trial-and-error phase through individualized analysis of genetic, physiological, and health parameters has the potential to improve drug tolerance, adherence, and long-term health benefits, as well as guide complementary therapies aimed at mitigating side effects.Several studies have recently demonstrated a link between the gut microbiome and statin use 13,14. Similar to other prescription drugs, statins are widely metabolized by gut bacteria into secondary compounds 15,16. This indicates that the gut microbiome may impact statin bioavailability or potency to its host, contributing to the interindividual variability in LDL response seen among statin users 17. Additionally, biochemical modification of statins by gut bacteria could potentially contribute to side effects of the drug 18. Independent of statins, the gut microbiome has a well characterized role in contributing to host metabolic health through regulating insulin sensitivity, blood glucose, and inflammation, hence sharing considerable overlap with off-target effects of statin therapy 19,20.Statin intake has also been implicated in shifting gut microbiome composition, where primarily obese individuals taking statins were less likely to be classified into a putative gut microbiome compositional state, or ‘enterotype’, defined by high relative abundance of Bacteroides and a depletion of short-chain fatty acid (SCFA) producing Firmicutes taxa 21. However, contradictory findings in animal models have also been reported, where a statin intervention decreased abundance of SCFA-producing taxa and, consequently, the gut ecosystem’s capacity to produce butyrate 22.Given the numerous documented interactions between the gut microbiome and statins, and the established effect of the gut microbiome on metabolic health, we sought to explore the potential role of the gut microbiome in modifying the effect of statins on inhibiting their target enzyme 3-hydroxy-3-methylglutarate-CoA (HMG-CoA) reductase, as well as influencing the negative side effects of statins on metabolic health parameters. We analyzed data from over 1840 deeply-phenotyped individuals with extensive medication histories, clinical laboratory tests, plasma metabolomics, whole genome and stool 16S rRNA gene amplicon sequencing data. We found that heterogeneity in statin on-target effects and off-target metabolic disruption could be explained by variation in the composition of the gut microbiome. Overall, our results suggest that, with further study and refinement, the taxonomic composition of the gut microbiome may be used to inform personalized statin therapies.

Abstract 14646: Internal Medicine Housestaff Perceptions of Statins and ACC/AHA Blood Cholesterol Guidelines

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Peter Flueckiger ◽  
Stephen Juraschek ◽  
Micah Eades ◽  
Amit Khera ◽  
Michael Blaha ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Side Effects ◽  
Statin Therapy ◽  
Perceived Risk ◽  
Gastrointestinal Symptoms ◽  
Blood Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Prescribing Practices ◽  
Ascvd Risk ◽  
Cholesterol Guidelines

Background: Statins are integral in the prevention of atherosclerotic cardiovascular disease (ASCVD). Provider perceptions and prescribing practices of statins vary. Internal medicine housestaff (HS) perceptions of statins and new ACC/AHA cholesterol guidelines have not previously been assessed. Methods: We examined internal medicine HS perceptions of statins and ACC/AHA cholesterol guidelines through a 48-question survey. We surveyed HS at three academic training programs. Anonymous responses were collected via a secure website. Results: 99 respondents’ results (84% categorical residents) were examined from Emory, Johns Hopkins, and UTSW. HS report observing low rates of statin side effects: 64% and 91% reported rates of <3% and <10%. Majority of side effects were myalgias (69%), transaminitis (23%), and gastrointestinal symptoms (5%). Over half (54%) of respondents check transaminases prior to statin therapy. If transaminitis >1-2x upper limit of normal (ULN) develop only 6% of residents stop statin therapy, though 62% stop therapy if transaminitis >3x ULN. In stable liver disease, 13% use non-statin therapy. Most residents (73%) agree that patients understand why they are prescribed statins and feel compliance is influenced by experienced/perceived risk of side effects (44%), cost (30%), and medical benefit (13%). However, HS do not discuss side effects in 25% of patients and only 44% agree patients frequently ask about side effects. Additionally, only 51% of HS discuss ASCVD risk with a majority of patients. HS perceive high rates of statin adherence (87% state >50% adherence at one year). Of 61 HS, 72% learned of new lipid guidelines through residency training. Nearly all (89%) read a portion of the guidelines and are likely to implement them (97%). However, only 57% agree the guidelines are clear or straightforward to apply in clinical practice and 66% agreed the guidelines will improve/reduce ASCVD risk. Only 48% agree new guidelines will improve quality of patient care. Conclusion: Practice patterns of statin therapy vary among medicine HS. Side effects and ASCVD risk are not frequently discussed with patients. Though HS are aware of new cholesterol guidelines, a gap exists between implementation and perceived benefits/ASCVD risk reduction.

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