New cholesterol guidelines: JAMA rates their quality

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Takeaway

Why this matters

  • Editorial: Following the guidelines would prevent “thousands if not millions” of CVD events worldwide.
  • Available at Univadis: 

Key highlights

  • JAMA provides a guidelines synopsis.
  • Statins are “bedrock” for all clinical CVD.
  • For patients with CVD who have very high risk for an event (e.g., older, familial hypercholesterolemia, coronary bypass history, diabetes, etc.):
    • intensify low-density lipoprotein target to
  • If target not achieved, turn to nonstatins:
    • ezetimibe (generic, cheaper) or 
    • a proprotein convertase subtilisin/kexin type 9 inhibitor.
  • Fasting lipid profile not needed unless triglycerides >400 mg/dL.
  • Obtain lipid profile when: 
    • doing risk estimation in adults, or 
    • with obesity/family history in children.
  • Drug management strongly recommended even without high risk if: 
    • Patient has clinical atherosclerotic (AS) CVD, LDL ≥190 mg/dL, diabetes.
    • Treatment target is >50% LDL reduction and
  • Graded targeting with ASCVD:
    • Target 50% LDL reduction with high-intensity statin.
    • With very high-risk ASCVD, then target