VIDEO: Preventive Cardiology in 2020: Room for Improvement

August 20, 2020

VIDEO: Treatment for ASCVD patients at high risk is lagging behind the availability of powerful new therapies. And, the pandemic does not help, according to Seth Baum, MD.

According to preventive cardiologist Seth J Baum, MD, high-risk ASCVD patients still are not receiving the newest, most powerful agents to help reduce chances of CV morbidity and mortality; he also talks about the impact of the COVID-19 pandemic on cardiovascular morbidity and mortality and discusess solutions.

The following transcript has been edited for length and clarity.

Patient Care: I guess the question is, how are we doing in terms benchmarks you're looking at?

Seth Baum, MD: So, again, let's make it, “How were we doing?” Okay? And then, "How are we doing?”

So how were we doing? We're doing better. If you use LDL as one of the benchmarks, unfortunately, individuals who were very high risk—now these are people who are categorized, they had one major heart attack or stroke or arterial disease syndrome, or two of those majors and, excuse me, one major and two minors or two majors. Well, if you look at those people, 70% of them have LDLs over 70—70%, okay? So we've got about 30% well controlled from an LDL standpoint. So how well are we doing? Not incredibly well.

Part of that problem is just not addressing LDL as though it's the enemy and we need to. Part of it is not going further with add-on therapies to statin therapy—that includes ezetimibe and PCSK9 inhibitors. When we've looked at that very high-risk group and seeing how many of them have had PCSK9 inhibitors prescribed, it's under 1%. Okay? Here we have the most powerful drug available to lower LDL cholesterol and fewer than 1% of people in the very high-risk group have had it prescribed by their clinician. So not doing well enough. Also, you know, with obesity rising, we not doing well enough. So, we have a lot of areas needed for improvement.

Now, fast forward to today. You know what's happening—people are gaining weight staying home, they're not exercising, staying home. They're staying home for their cardiovascular event. So, we're not at, we're not even preventing an actual event from occurring. People are dying out of the hospital more frequently than they had been. So, we have a decrease in the in hospital acute infarct and an increase in the out of hospital death, cardiovascular death. So that's because people are scared to go to the hospital. So, this is and that's a form of prevention, right? So, we're having problems. Yeah.