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Message: Re: Trying to understand placebo rste of MACE

Cabel,

Standard of care includes much more than just LDL-C control by statins.

Other standard of care drugs include ezetimibe (for LDL-C), PCSK9 antibodies (for LDL-C), ezetimibe (for LDL-C), Vascepa (for triglycerides), anti-platelet agents, anti-coagulants, various anti-hypertensive agents (i.e. beta blockers, calcium channel blockers, diuretics, renin-angiotensin system blocking agents), and various anti-diabetes therapies (i.e. insulin, metformin, thiazolidinediones, sulfonulureas, SGLT2 inhibitors, GLP1-R agonists), niacin and probably many others that I missed!

As you hopefully appreciate, management of LDL-C is only one of many risk factors for a high-risk diabetic with low-HDL and a recent ACS event! For sure, these patients will be on other standard of care drugs other than statins in BETonMACE. However, not all patients will be on the exact same standard of care mix. Diferent patients will have a slightly different clinical profile and/or drug tolerances requiring unique mix of medications to manage their risk factors. The only thing we know for certain is that all patients will be on either atorvastatin or rosuvastatin. I quickly glanced at the BETonMACE exclusion criteria and the only explicit exclusion I see for the above mentioned medications is "Use of fibrates at any dose or niacin/nicotinic acid 250+ mg w/in 30 days prior Visit 1."

You may want to take a look back at this post and the referenced paper/figure.

BearDownAZ

 

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