KOL Highlights

• Physicians will stick with old cholesterol guidelines in the short term, but in a few years transition to the new ones, as they will be easy to follow.
• If LDL-c is 10-15 mg/dl above the old goals, physicians do not feel compelled to treat.
• Once physicians adopt the new guidelines, they will be comfortable basing treatment on response to statins rather than goals. However, they will be reluctant to treat further if patients are already at the old goals with a suboptimal response.
• Estimates 10-15% are statin intolerant, but 60-70% can take some dose of a statin.
• Prior to outcomes study, would recommend PCSK9 inhibitors in limited numbers of patients. Positive results from ezetimibe’s IMPROVE-IT could influence him to prescribe more, though currently expects IMPROVE-IT to be negative.
• Discusses percent not meeting goal and projected usage of PCSK9 and CETP inhibitors in various scenarios based on outcomes data (see table in report for summary).
• Compliance expected to increase with PCSK9 inhibitors because of infrequent injections.
• Cognitive side effects would be a substantial issue for usage.
• Favors evolocumab monthly minidoser over pen injections because thought it may be less invasive (but could change with more details).