Cholesterol clinical practice guideline: a synopsis for internists

  • Ann Intern Med

  • International Clinical Digest
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Takeaway

  • Internists can take advantage of this synopsis of the 2018 multisociety cholesterol clinical practice guideline, with a diagram to guide decision-making in primary prevention.

Why this matters

Key results

  • Heart-healthy living should ideally begin in childhood.
  • Risk discussion between the clinician and patient is “still strongly recommended” in the primary prevention setting.
  • Patients can be triaged into 4 risk categories: low, borderline, intermediate, high.
  • For intermediate risk: have a focused discussion before starting statins, pinpoint factors enhancing risk, consider coronary artery calcium testing.
  • Focus on percentage reduction in low-density lipoprotein cholesterol (e.g., by at least 50%), long-term monitoring of treatment efficacy, with nonfasting lipid measures allowed.
  • For secondary prevention, with very high risk, patients might need to add nonstatins (e.g., ezetimibe or proprotein convertase subtilisin/kexin type 9) to statins. 
  • Flow diagram for primary prevention is available here .

Study design

  • A synopsis of guidelines specifically for the internal medicine audience.

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