AHA 2018 — AHA and ACC update cholesterol management guidelines


  • Hao Cheng, MD
  • Conference Reports
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • The American Heart Association (AHA) and the American College of Cardiology (ACC) have updated their clinical management guidelines for the management of hypercholesterolemia.

Why this matters

  • This is the first update to these guidelines since 2013.

Key recommendations

  • In very high risk atherosclerotic cardiovascular disease (ASCVD), consider augmenting statins with ezetimibe and a PCSK9 inhibitor.
  • In patients with severe primary hypercholesterolemia (low-density lipoprotein cholesterol [LDL-C] level ≥190 mg/dL [≥4.9 mmol/L]), begin high-intensity statin therapy.
  • In patients 40-75 years of age:
    • With diabetes and LDL-C ≥70 mg/dL (≥1.8 mmol/L), start moderate-intensity statin therapy.
    • Without diabetes and with LDL-C levels ≥70 mg/dL (≥1.8 mmol/L), calculate the 10-year ASCVD risk.
      • If risk is ≥7.5%, risk-enhancing factors favor statin therapy. These factors include family history, metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause, high-risk races/ethnicities, and others.
      • Consider measuring coronary artery calcium as a "tie-breaker." A score of "0" may indicate that statins can be withheld under certain conditions.
  • Assess adherence and response to LDL-C-lowering medications and lifestyle changes with repeat lipid measurement after statin initiation or adjustment.

Study design

  • An independent, multidisciplinary evidence review committee was commissioned to perform a formal systematic review of the clinical evidence.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit