Dyslipidemia is a key modifiable risk factor for cardiovascular (CV) disease, but the impact on CV risk varies by lipid disorder. Treatment has centered mainly on reducing the levels of atherogenic lipids, but physicians are increasingly seeking evidence of CV outcomes benefits. Numerous treatments are available, but few have solid evidence of CV benefit, and therapeutic approaches can vary. The recent launches of the novel proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, which are expected to deliver clinically meaningful improvements in outcomes, will reshape the current treatment paradigm.

Table of contents

  • Dyslipidemia - Current Treatment - Detailed, Expanded Analysis - PCSK9 Inhibitors In Dyslipidemia (US)
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Key Findings
        • Lipid Disorder Patient Volume
        • Genetic Lipid Disorders Patient Volume: Hypercholesterolemia Patients
        • CV Prevention Settings
        • Primary vs. Secondary Prevention: Dyslipidemia Subpopulations
      • Treatment Practices
        • Key Findings
        • Therapy Regimens Among CV Prevention Subpopulations - Endocrinologists (n = 51)
        • Therapy Regimens Among CV Prevention Subpopulations - Cardiologists (n = 50)
        • Current Therapy Regimens Among Dyslipidemia Subpopulations
        • Drugs/Drug Classes Currently Prescribed for Dyslipidemia Patients
        • Familiarity with PCSK9 Inhibitors
        • Key Findings
        • Percent of Dyslipidemia Patients Reaching Each Line of Therapy Within 365 Days of Diagnosis
        • Duration of Preceding Therapy Before Progressing to the Following Key Therapies
        • Key Findings
        • Endocrinologists’ Patients Prescribed Lipid-Modifying Therapies
        • Cardiologists’ Patients Prescribed Lipid-Modifying Therapies
        • Key Findings
        • Lipid-Modifying Patient Share Among CV Prevention Subpopulations - Endocrinologists (n = 51)
        • Lipid-Modifying Patient Share Among CV Prevention Subpopulations - Cardiologists (n = 50)
        • Key Findings
        • Average Time in Months Between Prematurely Discontinuing Dyslipidemia Patients’ Initiation and Discontinuation of Treatment
        • Key Findings
        • Key Findings
        • Line of Therapy Requirements for Drug-Treated Hypercholesterolemia Patients
        • Key Findings
        • Percentage of Drug-Treated Hypercholesterolemia Patients Prescribed Lipid-Modifying Therapies
        • Percentage of Drug-Treated Hypercholesterolemia Patients Prescribed Lipid-Modifying Therapies
        • Endocrinologists: Most Commonly Prescribed LDL-C-Lowering Therapy in Subsequent Lines of Treatment for Statin-Treated Hypercholesterolemia Patients
        • Cardiologists: Most Commonly Prescribed LDL-C-Lowering Therapy in Subsequent Lines of Treatment for Statin-Treated Hypercholesterolemia Patients
        • Endocrinologists - Most Commonly Prescribed LDL-C-Lowering Therapy in Subsequent Lines of Treatment for Statin-Intolerant Hypercholesterolemia Patients
        • Cardiologists - Most Commonly Prescribed LDL-C-Lowering Therapy in Subsequent Lines of Treatment for Statin-Intolerant Hypercholesterolemia Patients
        • First-line therapy
        • Second-line therapy
        • Third-line therapy
        • Key Findings
        • Percent of Dyslipidemia Patients Reaching Each Line of Therapy Within 365 Days of Diagnosis
        • Drug Progression Rates from First Line Therapy Among Newly Diagnosed Dyslipidemia Patients
        • Drug Progression Rates from Second-Line Therapy Among Newly Diagnosed Dyslipidemia Patients
        • Key Findings
        • Endocrinologists (n = 51) - Statin Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 50) - Statin Patient Share Among CV Prevention Subpopulations
        • Endocrinologists (n = 51) - Fibrate Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 44) - Fibrate Patient Share Among CV Prevention Subpopulations
        • Endocrinologists (n = 43) - Bile Acid Sequestrant Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 34) - Bile Acid Sequestrant Patient Share Among CV Prevention Subpopulations
        • Endocrinologists (n = 31) - Niacin + Statin FDC Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 27) - Niacin + Statin FDC Patient Share Among CV Prevention Subpopulations
        • Endocrinologists (n = 51) - Omega-3 Fatty Acid Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 39) - Omega-3 Fatty Acid Patient Share Among CV Prevention Subpopulations
        • Endocrinologists (n = 35) - PCSK9 Inhibitor Patient Share Among CV Prevention Subpopulations
        • Cardiologists (n = 39) - PCSK9 Inhibitor Patient Share Among CV Prevention Subpopulations
        • Endocrinologists - Nonstatin Monotherapy Patient Share Among CV Prevention Subpopulations
        • Cardiologists - Nonstatin Monotherapy Patient Share Among CV Prevention Subpopulations
        • Endocrinologists - Nonstatin Monotherapy Patient Share Among Dyslipidemia Subpopulations
        • Cardiologists - Nonstatin Monotherapy Patient Share Among Dyslipidemia Subpopulations
        • Key Findings
        • Drug Class Share by Line of Therapy in Dyslipidemia
        • Combination Therapy Levels Within Lines of Therapy for Dyslipidemia
        • Drug Burden by Line ofTherapy for Dyslipidemia
        • Percentage of Drug-Treated Dyslipidemia Patient Populations Prescribed Combination Lipid-Modifying Therapies
        • Percentage of Drug-Treated Dyslipidemia Patient Populations Prescribed Combination Lipid-Modifying Therapies
        • Percentage of Drug-Treated Dyslipidemia Patient Populations Prescribed Combination Lipid-Modifying Therapies
      • Persistency and Compliance
        • Key Findings
        • Percentage of Dyslipidemia Patients Who Discontinued Treatment Within the First Year
        • Average Time in Months Between Initiation of Treatment and Premature Discontinuation of Treatment
        • Reasons for Discontinuation of Lipid-Modifying Therapy
        • One-Year Persistence Among Dyslipidemia Patients (January 2014 through December 2014)
        • Compliance (Medication Possession Ratio) Among Dyslipidemia Patients
      • Sequencing of Treatment
        • Key Findings
        • Endocrinologists: Volume of Hypercholesterolemia Patients Currently Treated with LDL-C-Lowering Agents by Previous Treatment Setting
        • Cardiologists: Volume of Hypercholesterolemia Patients Currently Treated with LDL-C-Lowering Agents by Previous Treatment Setting
        • Endocrinologists: Volume of Hypercholesterolemia Patients Previously Treated with LDL-C-Lowering Agents by Current Treatment Setting
        • Cardiologists: Volume of Hypercholesterolemia Patients Previously Treated with LDL-C-Lowering Agents by Current Treatment Setting
        • Comparison of Adding and Switching Patterns: Key Therapy Sources
        • Endocrinologists: Most Likely LDL-C-Lowering Treatment to Add/Switch to Among Statin-Treated Hypercholesterolemia Patients
        • Cardiologists: Most Likely LDL-C-Lowering Treatment to Add/Switch to Among Statin-Treated Hypercholesterolemia Patients
        • Endocrinologists (n = 51): Physician-Preferred LDL-C-Lowering Drugs/Drug Classes in First and Subsequent Lines of Therapy for Hypercholesterolemia Patients
        • Cardiologists (n = 50): Physician-Preferred LDL-C-Lowering Drugs/Drug Classes in First and Subsequent Lines of Therapy for Hypercholesterolemia Patients
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • Key Findings
        • Endocrinologists: Changes in Overall Use of Treatment Approaches over the Past Year in Patients with Hypercholesterolemia
        • Cardiologists: Changes in Overall Use of Treatment Approaches over the Past Year in Patients with Hypercholesterolemia
        • Physicians’ Most Important Reason for Increased Use in the Last Year
        • Physicians’ Top Three Reasons for Increased Use in the Last Year
        • Physicians’ Most Important Reason for Reduced Use in the Last Year
        • Physicians’ Top Three Reasons for Reduced Use in the Last Year
        • Endocrinologists’ Top Reason for Increased Use in the Last Year
        • Cardiologists’ Top Reason for Increased Use in the Last Year
        • Cardiologists' Top Reason for Reduced Use in the Last Year
        • Endocrinologists: Expected Changes in Overall Use of Treatment Approaches in the Next Year for Patients with Hypercholesterolemia
        • Cardiologists: Expected Changes in Overall Use of Treatment Approaches in the Next Year for Patients with Hypercholesterolemia
        • Physicians Most Important Reason for Anticipated Increased Use in the Next Year
        • Physicians’ Top Three Reasons for Anticipated Increased Use in the Next Year
        • Physicians’ Most Important Reason for Expected Decline in Use in the Next Year
        • Physicians’ Top Three Reasons for Expected Decline in Use in the Next Year
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Key Findings
        • Overall Satisfaction with Hypercholesterolemia Drugs/Drug Classes
        • Overall Satisfaction with Hypercholesterolemia Drugs/Drug Classes by Specialty
        • Treatment Guidelines Followed for Dyslipidemia
        • Key Findings
        • Attribute Importance in Choice of Lipid-Modifying Therapies
        • Clinical Factors Influencing Choice of Treatment
        • Nonclinical Factors Influencing Choice of Treatment
        • Attribute Importance in Choice of Add-On Therapy for Statin-Treated Hypercholesterolemia Patients
        • Endocrinologists (n = 51): LDL-C Thresholds for Further LDL-C Treatment in Patients Receiving Maximally Tolerated Statin Treatment Who Have Residual CV Risk
        • Cardiologists (n = 50): LDL-C Thresholds for Further Treatment Among CV Prevention Subpopulations Receiving Maximally Tolerated Statin Treatments
        • Top Three Patient Populations Benefitting Most from PCSK9 Inhibitors by Specialty
        • Endocrinologists (n = 51): Impact of PCSK9 Inhibitor Availability on Prescription of Therapies for High LDL Cholesterol Levels
        • Cardiologists (n = 50): Impact of PCSK9 Inhibitor Availability on Prescription of Therapies for High LDL Cholesterol Levels
        • Key Findings
        • Factors That Drive Prescribing or Use of Crestor: Top 3
        • Factors That Drive Prescribing or Use of Crestor by Specialty
        • Factors That Drive Prescribing or Use of Atorvastatin: Top 3
        • Factors That Drive Prescribing or Use of Atorvastatin by Specialty
        • Factors That Drive Prescribing or Use of Zetia: Top 3
        • Factors That Drive Prescribing or Use of Zetia by Specialty
        • Factors That Drive Prescribing or Use of Vytorin: Top 3
        • Factors That Drive Prescribing or Use of Vytorin by Specialty
        • Factors That Drive Prescribing or Use of Repatha: Top 3
        • Factors That Drive Prescribing or Use of Repatha by Specialty
        • Factors That Drive Prescribing or Use of Praluent: Top 3
        • Factors That Drive Prescribing or Use of Praluent by Specialty
        • Endocrinologists: Superiority in Therapy Criteria by PCSK9 Inhibitors
        • Cardiologists: Superiority in Therapy Criteria by PCSK9 Inhibitors
        • Key Findings
        • Obstacles to Using Long-Term Statin Therapy in Hypercholesterolemia Patients
        • Dyslipidemia or ASCVD Patient Concerns Regarding Statin Treatment
        • Factors Constraining the Prescribing or Use of Crestor: Top 3
        • Factors Constraining the Prescribing or Use of Crestor by Specialty
        • Factors Constraining the Prescribing or Use of Atorvastatin: Top 3
        • Factors Constraining the Prescribing or Use of Atorvastatin by Specialty
        • Factors Constraining the Prescribing or Use of Zetia: Top 3
        • Factors Constraining the Prescribing or Use of Zetia by Specialty
        • Factors Constraining the Prescribing or Use of Vytorin: Top 3
        • Factors Constraining the Prescribing or Use of Vytorin by Specialty
        • Factors Constraining the Prescribing or Use of Repatha: Top 3
        • Factors Constraining the Prescribing or Use of Repatha by Specialty
        • Factors Constraining the Prescribing or Use of Praluent: Top 3
        • Factors Constraining the Prescribing or Use of Praluent by Specialty
        • Key Findings
        • Key Findings
        • Key Findings
      • Face-to-Face Product Detailing Effectiveness
        • Effectiveness of Face-to-Face Product Detailing
        • Key Findings
        • Physicians Ever Visited by Sales Representative for Repatha
        • Number of Visits in the Past Six Months: Repatha
        • Physicians Ever Visited by Sales Representative for Praluent
        • Number of Visits in the Past Six Months: Praluent
        • Endocrinologists: Last Contact
        • Cardiologists: Last Contact
        • Key Findings
        • Satisfaction with Sales Representative Among Recently Detailed Physicians
        • Satisfaction with Sales Representatives Among Recently Detailed Physicians
        • Key Findings
        • Sales Representatives’ Main Topics of Discussion
    • Appendix
      • Physician Demographics
        • Years in Practice Postresidency
        • Dyslipidemia Patients Under Personal Management in the Past Month
        • Endocrinologists (n = 51): U.S. Region of Practice
        • Cardiologists (n = 50): U.S. Region of Practice
        • Practice Type
        • Practice Location
    • Methodology
      • Survey
      • Significance Testing in This Study
      • Treatment Algorithms
      • Treatment Algorithms: Methodology
      • Treatment Algorithms: Methodology
      • Treatment Algorithms: Methodology
      • Products and Companies Profiled

Author(s): Tim Blackstock, MB, ChB, MPhil

Tim Blackstock, M.B. Ch.B., is a Director in Decision Resources Group’s Cardiovascular, Metabolic, Renal and Hematologic Disorders team focusing on dyslipidemia, obesity, and non-alcoholic steatohepatitis (NASH). In this role, he evaluates the latest primary and secondary research, as well as available commercial information, to forecast the potential of developmental drugs and provide insight on the various dynamics affecting relevant markets, as well as overseeing the work of team analysts across various metabolic and renal indications.

Tim holds a bachelor degrees in medicine and surgery from the University of Otago, New Zealand, and practiced medicine for five years, rotating through various specialties, including internal medicine, general surgery, and psychiatry. Prior to joining DRG, he was a writer in the medical communications industry, developing content for various media, as well as providing editorial assistance to leading pharmaceutical companies and medical experts across a variety of therapeutic areas.


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