Comparison of Transatlantic Approaches to Lipid Management: The AHA/ACC/Multisociety Guidelines vs the ESC/EAS Guidelines

• Published in: Mayo Clinic proceedings Vol. 95; no. 5; pp. 998 - 1014
• Main Authors: Singh, Maninder, McEvoy, John W., Khan, Safi U., Wood, David A., Graham, Ian M., Blumenthal, Roger S., Mishra, Abhishek K., Michos, Erin D.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.05.2020; Frontline Medical Communications Inc; Elsevier Limited
• Subjects: Arteriosclerosis; Atherosclerosis; Cardiology; Cardiovascular disease; Cardiovascular diseases; Cholesterol; Disease prevention; Lipids; Low density lipoprotein; Low density lipoproteins; Methods; Mortality; Risk assessment; Risk groups; Statins; CRP; PCSK9i; FH; NAFLD; RCT; SCORE; ASCVD; LDL-C; FRS; FOURIER; ABI; DM; ESC/EAS; IMPROVE-IT; apoB; CHS; HDL-C; REDUCE-IT; ARIC; OSA; CKD; LP(a); eGFR; SBP; CAC; PUFA; CARDIA; TC; AHA/ACC; CVD; CT; PCE; TG; HIV; hsCRP; LVH
• ISSN: 0025-6196; 1942-5546
• DOI: 10.1016/j.mayocp.2020.01.011

The 2018 American Heart Association/American College of Cardiology/Multisociety (AHA/ACC) guidelines and the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on lipid management were published less than a year apart. Both guidelines focus on reducing cardiovascular risk, but they follow different approaches in terms of methods of risk estimation, definitions of at-risk groups, and treatment goals to achieve this common underlying objective. Both recommend achieving risk-based percentage reductions of low-density lipoprotein cholesterol (LDL-C) levels with statin therapy. The ESC/EAS guidelines additionally recommend target LDL-C levels and are more liberal in supporting the use of both statin and nonstatin therapies across broader patient groups. The AHA/ACC guidelines may be considered more conservative, reserving the addition of nonstatins to maximally tolerated statins for only select patient groups based on specific LDL-C thresholds. One of the main reasons for these differences is incorporation of cost value considerations by the AHA/ACC guidelines, whereas the ESC/EAS guidelines consider an ideal setting with unlimited resources while making recommendations. In this review, we discuss similarities and differences between the 2 lipid guidelines to help clinicians become more cognizant of these recommendations and provide the best individualized patient care.