What lipid lowering treatments are common for ASCVD patients with familial hypercholesterolemia in Israel?
For patients with atherosclerotic cardiovascular disease (ASCVD) and familial hypercholesterolemia (FH) in Israel, the goal is to aggressively lower LDL cholesterol to reduce cardiovascular risk. Common treatments include high-intensity statins, ezetimibe, and PCSK9 inhibitors (such as evolocumab and alirocumab) or inclisiran. However, real-world data from Israel show that many patients still do not achieve recommended LDL-C targets, highlighting gaps in treatment intensification and adherence.
What the research says
A retrospective study using data from Maccabi Healthcare Services in Israel analyzed treatment patterns among patients with ASCVD, ASCVD-risk equivalent, and FH treated with lipid-lowering therapy between 2013 and 2019 2. The study found that despite treatment, many patients had uncontrolled LDL-C levels, indicating that current lipid-lowering therapy (LLT) is often insufficient 2. International guidelines, such as those from the International Lipid Expert Panel (ILEP), recommend a 'lower is better for longer' approach and emphasize the need for early and intensive LLT in very high-risk patients, including those with FH and ASCVD 9. The ILEP position paper highlights that in addition to statins, ezetimibe, bempedoic acid, and PCSK9 modulators (PCSK9 inhibitors and inclisiran) are effective options for those at very high and extremely high cardiovascular risk 9. Inclisiran, a twice-yearly injectable PCSK9 modulator, has been shown to effectively reduce LDL-C in patients with heterozygous FH and ASCVD when added to maximally tolerated statins 10. The 2018 AHA/ACC cholesterol guideline also recommends high-intensity statin therapy as first-line for patients with ASCVD, with ezetimibe and PCSK9 inhibitors as add-on therapy if LDL-C remains above target 11. In Israel, these therapies are available and used, but the real-world study indicates that treatment patterns may not always align with guideline recommendations, as many patients remain uncontrolled 2.
What to ask your doctor
- What is my current LDL-C goal given my ASCVD and FH diagnosis?
- Am I on a high-intensity statin, and if so, is my dose maximized?
- Would adding ezetimibe or a PCSK9 inhibitor (like evolocumab, alirocumab, or inclisiran) help me reach my LDL-C target?
- How often should I have my lipid levels checked to monitor treatment effectiveness?
- Are there any newer therapies, such as bempedoic acid or inclisiran, that might be appropriate for me?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.