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