Program Overview
The economic burden of cardiovascular disease (CVD), the leading cause of morbidity and mortality in the United States, was in excess of $400 billion in 2006. Treatment of dyslipidemia, a significant risk factor for the development of CVD, results in savings of $15,000 to $20,000 per life-year saved based on an average 10-year risk. Although studies have demonstrated a reduction in CVD risk when patients achieve low-density lipoprotein cholesterol (LDL-C)-lowering goals using various statins, there remains the potential for significant further risk reduction. This persistent risk is attributable, in part, to elevated triglyceride (TG ) levels. Triglycerides have been established as an independent predictor of CVD, and reduction of TG levels is associated with improved clinical outcomes. Purified omega-3-acid ethyl esters (P-OM3) (eicosapentaenoic acid/docosahexaenoic acid) represent alternatives to fibrates and nicotinic acid for treating patients with elevated TG . However, most patients with CVD have multiple lipid abnormalities and may require combination therapy. For patients with elevated LDL-C and TG levels, non-high-density lipoprotein cholesterol (non-HDL-C), defined as total cholesterol minus HDL-C, may be a better predictor of CVD than LDL-C. Clinical studies, such as the COMBination of prescription Omega-3 with Simvastatin (COMBOS) trial, support the use of statins plus P-OM3 for patients with mixed dyslipidemia. Furthermore, several large clinical trials are under way to assess the role of statins in combination with either a fibrate (ACCORD) or extended-release niacin (AIM-HIGH, HPS2-THRIVE).
This symposium will review approaches for assessing CVD risk in patients with elevated TG and non-HDL-C; the pharmacologic properties, efficacy, and cost benefits of therapies for the management of mixed dyslipidemia; and best evidence for developing clinical recommendations designed to optimize the pharmacologic treatment of mixed dyslipidemia. This is particularly important to managed care pharmacists, who are responsible for understanding how current treatment strategies influence outcomes, access, quality, and cost for providers, patients, and health benefits payers.
