Recent Update to the US Cholesterol Treatment Guidelines

Abstract

The 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Guideline advocated several changes from the previous Adult Treatment Panel III (ATP III) Guidelines. Assuming full implementation, the 2013 ACC/AHA Guideline would identify approximately 13 million Americans to be newly eligible for consideration of statin therapy. Three features of the 2013 ACC/AHA Guideline primarily responsible for these differences are the specific risk assessment tool endorsed, the risk threshold considered sufficient to warrant primary prevention statin therapy, and the decision to not include cholesterol treatment targets. There is no consensus among international guidelines regarding the optimal approach to these three components. The 2013 ACC/AHA Guideline recommends assessing absolute risk with the pooled cohort equations, which were developed to improve upon previous risk assessment models by including stroke as an outcome and by broadening racial and geographic diversity. Leading international guidelines each recommend a different equation for absolute risk assessment. The 2013 ACC/AHA Guideline advises consideration of statin therapy for an estimated 10-year risk of atherosclerotic vascular disease of ≥7.5%, which is lower than the thresholds recommended by other leading international guidelines. Lastly, the 2013 ACC/AHA Guideline does not endorse a treat-to-target strategy, but instead specifies the appropriate intensity of statin for each risk category. This approach is shared by the National Institute for Health and Care Excellence (NICE) Guidelines but differs from other international guidelines. In this review, we summarize the 2013 ACC/AHA Cholesterol Guideline recommendations and compare them with recommendations from ATP III and other leading international guidelines.

Burden of comorbidities is higher among elderly survivors of oropharyngeal cancer compared with controls

“…This finding highlights the question of whether survivors of OPC may benefit from more stringent targets for cholesterol management and other targeted stroke reduction interventions, as has been recommended in other high-risk populations, such as those individuals with diabetes. 41 This represents an area of future investigation.…”

Moving Beyond Clinical Risk Scores with a Mobile App for the Genomic Risk of Coronary Artery Disease

“…When the predicated and observed risk of cardiovascular events for 4,854 participants in the Rotterdam Study was compared using ACC/AHA, ATP-III and ESC criteria, all three independent prediction tools vastly overestimated risk. There are also dramatic differences between the various risk prediction tools and in the expert guidelines from international societies [5]. For example, ACC/AHA guidelines would have recommended statin therapy for 96.4% of men, compared with 52.0% by ATP-III and 66.1% by ESC criteria [6].…”

Targeting LDL Cholesterol: Beyond Absolute Goals Toward Personalized Risk

“…They stated that each 38.7 mg/dL (1.0 mmol/L) reduction in LDL-C, with a standard statin regimen, reduced the incidence of major vascular events (defined as nonfatal myocardial infarction or coronary death, any stroke, or coronary revascularization procedure) by about 20% [30]. While the authors did not mention an absolute lower LDL-C threshold, this meta-analysis became a key reference for both American and European guidelines recommending that clinicians pursue LDL-C levels lower than 70 mg/dL (1.8 mmol/L) [6, 7]. …”

“…More recently, amendments to guidelines have resulted in substantial discrepancies between the various sets of recommendations in different regions. Some recommend statin treatment according to population-based risk stratification and intensity of treatment while others maintain LDL-C treatment targets [6, 7]. One element that is shared across updated guidelines is that there are varying levels of risk among population subgroups.…”