2013 ACC/AHA cholesterol treatment guideline: Paradigm shifts in managing atherosclerotic cardiovascular disease risk

• Published in: Trends in cardiovascular medicine Vol. 25; no. 4; pp. 340 - 347
• Main Authors: Finkel, Jonathan B., MD, Duffy, Danielle, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2015; Elsevier Limited
• Subjects: American Heart Association; Biomarkers - blood; Cardiology; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - blood; Cardiovascular Diseases - drug therapy; Cholesterol; Cholesterol, LDL - blood; Coronary Artery Disease - blood; Coronary Artery Disease - drug therapy; Guidelines as Topic; Heart attacks; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Meta-Analysis as Topic; Peripheral Arterial Disease; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Risk Reduction Behavior; Statins; Stroke - prevention & control; Treatment Outcome; United States; United States
• ISSN: 1050-1738; 1873-2615
• DOI: 10.1016/j.tcm.2014.10.015

Abstract The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults represents a major shift from prior cholesterol management guidelines. The new guidelines include data from individual randomized trials as well as the most comprehensive meta-analyses, and introduce several major paradigm shifts, which include: aiming for ASCVD risk reduction as opposed to targeting LDL-C levels, advocating for the use of evidence-based doses of statins as first line therapy, and utilizing a new risk calculator and risk cut point to guide initiation of statin therapy. These major changes have created controversy and confusion among the medical community, with some clinicians hesitant to embrace the shift. We review the evidence that forms the basis for these major changes, compare them to other major lipid guidelines, and recommend an integrated approach to managing dyslipidemia to decrease atherosclerotic cardiovascular disease risk.