Lack of accurate evidence on non-statin medication in patients receiving highintensity statin therapy: Re-evaluation of recommendations is needed

Despite high-intensity statin therapy (HIST), cardiovascular events persist. Therefore, non-statin medication (NSM) drugs have been developed. However, the patient group to which these drugs should be administered is unclear. The American Heart Association (AHA) published a NSM recommendation to address this question (1). However, we believe that some elements of the updated 2017 recommendation warrant more investigation. Five important studies pertaining to the guidelines on NSM have recently been published. However, the number of patients receiving HIST in all studies, with the exception of one study, was inadequate. The percentage of patients receiving HIST was as follows: ODYSSEY, 46.8%; FOURIER, 69%; SPIRE-II, 73%; SPRIRE-I, 91% patients; and IMPROVE-IT was conducted with 40-mg simvastatin; therefore, no HIST was used (2-5). Only the SPIRE-I study could suggest that NSM is beneficial or not for patients receiving HIST. However It was shown that adding PCSK9- I (bococizumab) in the regimen of patients receiving HIST has no additional benefit for patients with LDL-C ≥70<100 mg/dL. In SPIRE-II, bococizumab was found to be beneficial for patients with LDL-C ≥100 mg/dL