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
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit