New cholesterol guidelines: the top-10 take-homes

  • Grundy SM & al.
  • J Am Coll Cardiol
  • 8 Nov 2018

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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  • The American College of Cardiology (ACC) has synthesized the new cholesterol guidelines into 10 key take-home messages.
  • ACC also has created a hub of related resources for clinicians and patients.  

Why this matters

  • The latest cholesterol guidelines call for combining atherosclerotic cardiovascular disease (ASCVD) risk score with “risk enhancer” factors to personalize decision-making.
  • The new recommendations introduce some necessary complexity.

Key messages

  • Emphasize heart-healthy living for all patients.
  • Take-homes 2-5 (risk assessment not needed for the following):
    • Use high-intensity statins for secondary prevention to reduce low-density lipoprotein (LDL) cholesterol by ≥50%.
    • With very-high-risk ASCVD, LDL target is
    • With LDL-C ≥190 mg/dL, start on high-intensity statins.
    • In adults aged 40-75 years with diabetes and LDL ≥70 mg/dL, start on moderate-intensity statin, targeting
  • Take-homes 6-9 (use risk calculation for adults, 40-75 years, no diabetes):
    • Use 10-year ASCVD risk, evaluate risk enhancers, treatment costs.
    • With 10-year ASCVD ≥7.5% plus LDL ≥70 mg/dL, moderate-intensity statin warranted.
    • 10-year ASCVD 5%-19.9%, statin therapy favored.
    • With LDL ≥70-189 mg/dL, 10-year ASCVD risk ≥7.5%-19.9%, if still uncertain, consider measuring coronary artery calcium (0=possibly no statin needed; 1-99, statins favored; ≥100 or ≥75th percentile, statins indicated).
  • Finally, assess adherence, response with LDL measurements 4-12 weeks after statin start or dose change, then every 3-12 months as needed.

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