Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Synopsis of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline

Abstract

This synopsis summarizes key features of the guidelines in 8 areas: lifestyle, groups shown to benefit from statins, statin safety, decision making, estimation of cardiovascular disease risk, intensity of statin therapy, treatment targets, and monitoring of statin therapy.

Midlife Cardiovascular Risk Factors and Late‐Life Unrecognized and Recognized Myocardial Infarction Detect by Cardiac Magnetic Resonance: ICELAND‐MI, the AGES‐Reykjavik Study

“…MI itself can alter BP or cholesterol through pathophysiologic change, or prescription of drugs or diet, but the baseline midlife Reykjavik data are unlikely to have this limitation because the mean age was 48 years and probably before onset of MI in most cases. In the 1970s and 1980s, cardiovascular risk factor management was not as well defined as in current practice guidelines, which have lower thresholds for intervention for prehypertension and hypercholesterolemia 50, 52, 58. In the Reykjavik study, the baseline mean systolic and diastolic BPs at midlife were in the prehypertension range and higher than mean BPs reported in a recent National Health and Nutrition Examination Survey 59…”

Gestione del rischio cardiovascolare nel paziente HIV positivo

“…I fibrati rappresentano il trattamento farmacologico elettivo per l'ipertrigliceridemia e per l'iperlipidemia mista, mentre le statine (e in alternativa l'ezetimibe) sono i farmaci raccomandati per l'ipercolesterolemia. Le Linee Guida dell'ACC-AHA del 2013 raccomandano il trattamento farmacologico dell' ipercolesterolemia con statine in quattro possibili situazioni cliniche: 1) diagnosi di malattia cardiovascolare aterosclerotica (infarto miocardico o ictus cerebrale); 2) diagnosi di diabete mellito ed età compresa tra 40 e 75 anni; 3) colesterolo LDL >190 mg/dL; 4) rischio a 10 anni di malattia cardiovascolare (secondo lo score ACC-AHA) elevato (ovvero ≥ 7.5%) (40). Le Linee Guida EACS del 2015 raccomandano la terapia con statina nel soggetto HIV-positivo se il colesterolo LDL è >115 mg/dL e si verifica una di queste tre condizioni: 1) diagnosi di malattia cardiovascolare; 2) diagnosi di diabete mellito tipo II; 3) rischio cardiovascolare (secondo lo score di Framingham) moderato o elevato (ovvero ≥ 10%) (12).…”

“…In particolare tale terapia è raccomandata nei pazienti con diagnosi di malattia cardiovascolare aterosclerotica, diabete mellito, rischio cardiovascolare elevato (ovvero >7.5% secondo lo score ACC-AHA) o colesterolo LDL >190 mg/dL (12,22,40). La terapia antiaggregante con acido acetilsalicilico o equivalenti dovrebbe sempre essere considerata, se non controindicata, nei pazienti HIV-positivi con diagnosi di malattia cardiovascolare aterosclerotica o in età maggiore di 50 anni e con rischio cardiovascolare da intermedio ad elevato (ovvero >2.5% secondo lo score ACC-AHA) (12,41).…”

Statin and Aspirin Use Among Hispanic and Latino Adults at High Cardiovascular Risk: Findings From the Hispanic Community Health Study/Study of Latinos

“…Cardiovascular medications such as statins and aspirin are widely used in the United States1 and are critical for primary and secondary prevention of cardiovascular disease (CVD),2, 3, 4, 5 which is increasingly common in the growing and aging US Hispanic/Latino population. Despite evidence of disparities in CVD and CVD risk factors, including hypercholesterolemia, among adults from the diverse Hispanic/Latino groups that compose the US Hispanic/Latino population,6 current information on use of medications for the prevention of CVD, including statins and aspirin, is limited.…”