The updated American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol (GTBC) has been long-awaited since the latest update of the Adult Treatment Panel III (ATP III) guidelines in 2004. The updated GTBC recommends a significant paradigm shift in lipid-loweringdrug therapy for atherosclerotic cardiovascular disease (ASCVD) risk reduction, which has led to questions regarding their content and their implementation.
Summary of the ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCVD
1. Persons >/= 21 y who fall into any of the following 4 at-risk groups are to be considered for statin therapy to reduce ASCVD risk:
a. Known ASCVD
b. LDL-C level >190 mg/dL
c. Diabetes, aged 40-75 y, with LDL-C levels of 70-189 mg/dL
d. 10-y risk of cardiac event or stroke >/= 7.5% (by the Pooled Cohort Risk Calculator)
2. Lipid-lowering statin therapy should be based on the degree of ASCVD risk and the intensity of the statin. High-intensity statin therapy* is recommended for patients with known ASCVD, LDL-C levels >190 mg/dL, and DM, with 10-y risk >7.5%. Moderate-dose statin therapy** is recommended for the other treatment groups (patients with DM but with 10-y risk <7.5% and those without DM who have a 10-y risk >7.5%).
3. The expert panel did not recommend for or against LDL-C goals or targets but rather recommends that lipids be checked at baseline and then 4-12 wk after initiating statin therapy to assess adherence and response to therapy. Individuals receiving high-dose statin therapy would be expected to lower their LDL-C level by >50% from their baseline level, and those receiving moderate-dose statin therapy would be expected to lower their LDL-C level by 30%-49%.
4. Consider rechecking lipid levels every 3-12 mo as clinically indicated. Reassess lifestyle therapy on a regular basis.
5. Shared decision making should be performed between providers and patients when considering the use of statin therapy for ASCVD risk reduction.
6. The expert panel notes that these clinical guidelines, although based on evidence, should not replace clinical judgment, particularly in patients who fall outside of the 4 categories listed in item 1 but who still may be at elevated ASCVD risk (eg, patients with a family history of early ASCVD).
7. These guidelines are not meant to be inclusive of all types of hyperlipidemia. Patients with complex hyperlipidemias should be referred to a lipid specialist for evaluation and treatment recommendations.
Abbreviations: ACC/AHA = American College of Cardiology/American Heart Association; ASCVD = atherosclerotic cardiovascular disease; DM = diabetes mellitus; LDL-C = low-density lipoprotein cholesterol.
* High-intensity therapy (50% LDL-C reduction): atorvastatin, 40-80 mg; rosuvastatin, 20-40 mg.
**Moderate-intensity therapy (30%-49% LDL-C reduction): atorvastatin, 10-20 mg; rosuvastatin, 5-10 mg; simvastatin, 20-40 mg; pravastatin, 40-80 mg; lovastatin, 40 mg; fluvastatin XL, 80 mg; fluvastatin, 40 mg twice daily; pitavastatin, 2-4 mg.
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