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:
- Known ASCVD
- LDL-C level >190 mg/dL
- Diabetes, aged 40-75 y, with LDL-C levels of 70-189 mg/dL
- 10-y risk of cardiac event or stroke >/= 7.5% (by the Pooled Cohort Risk Calculator)
- 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%).
- 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%.
- Consider rechecking lipid levels every 3-12 mo as clinically indicated. Reassess lifestyle therapy on a regular basis.
- Shared decision making should be performed between providers and patients when considering the use of statin therapy for ASCVD risk reduction.
- 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).
- 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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