- JAMA gives the new multi-association/society cholesterol guidelines a thumbs-up.
- Accompanying editorial calls the new guidelines “a significant and positive step forward” in preventing cardiovascular disease (CVD).
- Rating breakdown is available here .
Why this matters
- Editorial: Following the guidelines would prevent “thousands if not millions” of CVD events worldwide.
- Available at Univadis:
- 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