(HealthDay News) — In a clinical practice guideline published online May 4 in The BMJ, risk-stratified recommendations are presented for whether another lipid-lowering drug should be added among adults with low-density lipoprotein (LDL) cholesterol levels >1.8mmol/L (>70mg/dL) who are already taking the maximum dose of statins or who are intolerant to statins.

Qiukui Hao, MD, from Sichuan University in Chengdu, China, and colleagues reviewed the evidence from 14 trials with 83,660 participants to explore whether another lipid-lowering drug should be added for adults with LDL cholesterol levels >70mg/dL who are already taking the maximum dose of statins or are intolerant to statins.

The recommendations provided by the panel were mostly weak, so shared decision making with patients is advised when applying them. The panel states that for adults with LDL cholesterol >70mg/dL, on the maximum dose of statins or intolerant to statins, addition of a lipid-lowering drug is not recommended for those who are at low cardiovascular risk.

When considering the addition of a lipid-lowering drug for those on the maximum dose of statins or intolerant to statins who are at high or very high cardiovascular risk, ezetimibe is suggested in preference to a proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitor.

“Because of the anticipated large variability of patients’ values and preferences, well informed choices warrant shared decision making,” the authors write.

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