2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

• Published in: Journal of the American College of Cardiology Vol. 73; no. 24; pp. 3168 - 3209
• Main Authors: Grundy, Scott M, Stone, Neil J, Bailey, Alison L, Beam, Craig, Birtcher, Kim K, Blumenthal, Roger S, Braun, Lynne T, de Ferranti, Sarah, Faiella-Tommasino, Joseph, Forman, Daniel E, Goldberg, Ronald, Heidenreich, Paul A, Hlatky, Mark A, Jones, Daniel W, Lloyd-Jones, Donald, Lopez-Pajares, Nuria, Ndumele, Chiadi E, Orringer, Carl E, Peralta, Carmen A, Saseen, Joseph J, Smith, Jr, Sidney C, Sperling, Laurence, Virani, Salim S, Yeboah, Joseph
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 25.06.2019
• Subjects: Age; American Heart Association; Anticholesteremic Agents - pharmacology; Arteriosclerosis; Biomarkers - blood; Body mass index; Calcification (ectopic); Calcium; Cardiology; Cardiology - methods; Cardiology - standards; Cardiovascular disease; Cardiovascular Diseases - prevention & control; Cardiovascular Diseases - psychology; Cholesterol; Clinical decision making; Clinical practice guidelines; Clinical trials; Coronary artery; Decision making; Diabetes; Disease prevention; Drug dosages; Ethnicity; Ezetimibe - pharmacology; Guidelines; Health behavior; Hispanic Americans; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hypercholesterolemia - blood; Hypercholesterolemia - diagnosis; Hypercholesterolemia - epidemiology; Hypercholesterolemia - therapy; Inflammatory diseases; Inhibitors; Lifestyles; Low density lipoprotein; Medication Therapy Management - standards; Metabolic syndrome; Patient compliance; Patients; Proliferating cell nuclear antigen; Proprotein Convertase 9 - antagonists & inhibitors; Risk analysis; Risk Assessment - methods; Risk factors; Risk Reduction Behavior; Statins; Task forces; Therapy; United States; White people; United States; ACC/AHA Clinical Practice Guidelines; cardiovascular disease; patient compliance; risk assessment; lipids; drug therapy; risk reduction discussion; secondary prevention; hydroxymethylglutaryl-CoA reductase inhibitors/statins; biomarkers; proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9) inhibitors; diabetes mellitus; hypercholesterolemia; pharmacological; Guidelines; LDL-cholesterol; coronary artery calcium score; ezetimibe; primary prevention; cholesterol; risk treatment discussion
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2018.11.002

Throughout these guidelines similar to the 2013 guidelines, consistent attention is given to a clinician–patient risk discussion for making shared decisions. Besides major risk factors of the pooled cohort equations (PCE), the clinician–patient risk discussion can include other risk-enhancing factors, and when risk status is uncertain, a coronary artery calcium (CAC) score is an option to facilitate decision-making in adults ≥40 years of age. Another study projected a similar improvement in economic value (S7.1-6). [...]raising the threshold for LDL-C on maximal statin therapy to initiate a PCSK9 inhibitor should improve its cost-effectiveness (Figure 3). [...]the value of PCSK9 inhibitor therapy in FH is uncertain.8 Limitations and Knowledge Gaps 8.1 Randomized Controlled Trials ACC/AHA guidelines are based largely on the outcomes of RCTs. [...]the clinician–patient risk discussion should include more than the initial treatment decision.