Up to Date not very Up to Date on Lipid therapy

This Consensus statement  below
 came out before the last review of the literature by UP TO DATE

A Consensus Approach to the Use of Non-Statin Therapy for Atherosclerotic Cardiovascular Disease Prevention - See more at: http://www.acc.org/latest-in-cardiology/articles/2016/04/07/14/32/a-consensus-approach-to-the-use-of-non-statin-therapy-for-atherosclerotic-cardiovascular-disease-prevention#sthash.anm24eQB.dpuf

A Consensus Approach to the Use of Non-Statin Therapy for Atherosclerotic Cardiovascular Disease Prevention

A Consensus Approach to the Use of Non-Statin Therapy for Atherosclerotic Cardiovascular Disease Prevention - See more at: http://www.acc.org/latest-in-cardiology/articles/2016/04/07/14/32/a-consensus-approach-to-the-use-of-non-statin-therapy-for-atherosclerotic-cardiovascular-disease-prevention#sthash.anm24eQB.dpuf

"Unlike the ACC/AHA Blood Cholesterol Guideline, but consistent with the NLA Recommendations Part II,4
the ECDP gives recommendations
on the order in which specific non-statin therapies should be considered, providing a perspective that is useful to the practicing clinician.

 Generally, ezetimibe is recommended as the initial add-on agent, based upon its demonstrated efficacy in ASCVD risk reduction, tolerability, safety and low pill burden.

Bile acid resins are generally reserved for those who require additive therapy, but are unable to tolerate ezetimibe.

PCSK9 inhibitors are recommended for consideration solely in high risk individuals with ASCVD or LDL-C ≥190 mg/dL after therapy with the previously mentioned agents fail to provide sufficient additional LDL-C lowering, but these agents are not recommended in those with these conditions who are pregnant or imminently contemplating pregnancy."

 My opinion.
It's outrageous to not include Niacin at 1,000 mg as an alternative drug. 
It has many trials of success behind it. 
It can be purchased over the counter very inexpensively. 
It is very safe at low dose. 
Used with low dose statin it is very effective at lowering LDLc. 

PCSK9 inhibitors cost $1,000 a month and have no outcome studies. 

AIM-HIGH trial was stopped after 3 years for non-significant bad side effects. 
 If trial continued as long as the Zetia trial it would probably have had a positive trial.  
AIM-HIGH data from Dr Terry Jacobson slide from Masters Program NOLA, NLA 2016

Unlike the ACC/AHA Blood Cholesterol Guideline, but consistent with the NLA Recommendations Part II,4 the ECDP gives recommendations on the order in which specific non-statin therapies should be considered, providing a perspective that is useful to the practicing clinician. Generally, ezetimibe is recommended as the initial add-on agent, based upon its demonstrated efficacy in ASCVD risk reduction, tolerability, safety and low pill burden. Bile acid resins are generally reserved for those who require additive therapy, but are unable to tolerate ezetimibe. PCSK9 inhibitors are recommended for consideration solely in high risk individuals with ASCVD or LDL-C ≥190 mg/dL after therapy with the previously mentioned agents fail to provide sufficient additional LDL-C lowering, but these agents are not recommended in those with these conditions who are pregnant or imminently contemplating pregnancy. - See more at: http://www.acc.org/latest-in-cardiology/articles/2016/04/07/14/32/a-consensus-approach-to-the-use-of-non-statin-therapy-for-atherosclerotic-cardiovascular-disease-prevention#sthash.rZvrT124.dpuf

Unlike the ACC/AHA Blood Cholesterol Guideline, but consistent with the NLA Recommendations Part II,4 the ECDP gives recommendations on the order in which specific non-statin therapies should be considered, providing a perspective that is useful to the practicing clinician. Generally, ezetimibe is recommended as the initial add-on agent, based upon its demonstrated efficacy in ASCVD risk reduction, tolerability, safety and low pill burden. Bile acid resins are generally reserved for those who require additive therapy, but are unable to tolerate ezetimibe. PCSK9 inhibitors are recommended for consideration solely in high risk individuals with ASCVD or LDL-C ≥190 mg/dL after therapy with the previously mentioned agents fail to provide sufficient additional LDL-C lowering, but these agents are not recommended in those with these conditions who are pregnant or imminently contemplating pregnancy. - See more at: http://www.acc.org/latest-in-cardiology/articles/2016/04/07/14/32/a-consensus-approach-to-the-use-of-non-statin-therapy-for-atherosclerotic-cardiovascular-disease-prevention#sthash.rZvrT124.dpuf

Unlike the ACC/AHA Blood Cholesterol Guideline, but consistent with the NLA Recommendations Part II,4 the ECDP gives recommendations on the order in which specific non-statin therapies should be considered, providing a perspective that is useful to the practicing clinician. Generally, ezetimibe is recommended as the initial add-on agent, based upon its demonstrated efficacy in ASCVD risk reduction, tolerability, safety and low pill burden. Bile acid resins are generally reserved for those who require additive therapy, but are unable to tolerate ezetimibe. PCSK9 inhibitors are recommended for consideration solely in high risk individuals with ASCVD or LDL-C ≥190 mg/dL after therapy with the previously mentioned agents fail to provide sufficient additional LDL-C lowering, but these agents are not recommended in those with these conditions who are pregnant or imminently contemplating pregnancy. - See more at: http://www.acc.org/latest-in-cardiology/articles/2016/04/07/14/32/a-consensus-approach-to-the-use-of-non-statin-therapy-for-atherosclerotic-cardiovascular-disease-prevention#sthash.rZvrT124.dpuf