Across the Atlantic, the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guideline for the management of dyslipidemias have included bempedoic acid as a potential novel therapy for LDL-C lowering.15 We eagerly await data on the impact of bempedoic acid on cardiovascular outcomes. Considering the well-established association of LDL-C with ASCVD, and experience thus far with bempedoic acid, a significant reduction is fully anticipated in the primary endpoint in the ongoing CLEAR Outcomes trial. Currently, bempedoic acid is FDA approved for ASCVD secondary prevention or primary prevention in patients with HeFH as an adjunct to diet and maximally tolerated statin therapy.
Similar data issues also exist in other COVID-19 data sources. For example, hospitalization data may not capture cases equally across various geographical areas if there are large differences in catchment areas or considerable discrepancies in healthcare seeking behaviors. Additionally, the proportion of cases hospitalized might decline as hospitals become overwhelmed with patients and are only able to accept the most severe cases at particular points in the pandemic. COVID-19 mortality data, meanwhile, may suffer from challenges in determining what constitutes a COVID-19 attributed death and differences in the amount of time it takes to report deaths, if they are reported at all. While excess mortality data must grapple with other disruptions to the norm outside of COVID-19 deaths, such as the potential impact of people delaying or refusing treatment, cancellation of elective surgeries, possible increases in mental health-related deaths, and likely decreased spreading of other infectious diseases as a result of COVID-19 interventions.
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