2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults3

LDL-C treatment threshold of ≥ 1.8 mmol/L is recommended for intensifying lipid-lowering therapy with a PCSK9 inhibitor (± ezetimibe) in secondary CV prevention patients on maximally tolerated statin dose.*

Selected recommendations on intensification of lipid-lowering therapy

In patients with ASCVD on maximally tolerated statin dose, intensification of lipid-lowering therapy is recommended with:

  1. A PCSK9 inhibitor ± ezetimibe for secondary CV prevention in patients with LDL-C ≥ 1.8 mmol/L who are appropriate for PSCK9 inhibitor therapy (Assigned a strong recommendation based on moderate quality evidence)
  2. Ezetimibe and/or a PCSK9 inhibitor for all secondary prevention CVD patients in whom LDL-C remains ≥ 1.8 mmol/L (or non-HDL-C ≥ 2.4 mmol/L or ApoB ≥ 0.7 g/L). PCSK9 inhibitor therapy is recommended if LDL-C remains ≥ 1.8 mmol/L on initial ezetimibe therapy. (Assigned a strong recommendation based on high quality evidence)

Additional lipid-lowering therapy with ezetimibe and PCSK9 inhibitors may also be considered for ASCVD patients with an LDL-C < 1.8 mmol/L, especially those at high risk for recurrent ASCVD events.

Please see the complete guidelines for all 2021 CCS Dyslipidemia Guideline recommendations.

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