New Lipid Guidelines – Hooray!

This week, the American College of Cardiology and American Heart Association (ACC/AHA) released new guidelines for the management of Lipids.

The new guidelines are a major shift in thinking. They are far closer to the proposed POQ in the discussion elsewhere on this site than to the previous guidelines. Spooky. This is clearly cause and effect. Who would have thought we had that much influence?

Key points in new guidelines.

Treating to LDL cholesterol targets is no longer recommended.

Patients should receive Statins if they fall into one of these four groups.

  • Patients with clinical atherosclerotic cardiovascular disease (ASCVD) should receive high-intensity (age, <75) or moderate-intensity (age, ≥75) statin therapy.
  • Patients with LDL cholesterol levels ≥ 4.9 mmol/L should receive high-intensity statin therapy.
  • Diabetic patients aged 40–75 with LDL cholesterol levels of 1.8–4.9 mmol/L and without clinical ASCVD should receive at least moderate-intensity statin therapy (and possibly high-intensity statin therapy when estimated 10-year ASCVD risk is ≥7.5%).
  • Patients without clinical ASCVD or diabetes but with LDL cholesterol levels of 1.8-4.9 mg/dL and estimated 10-year ASCVD risk ≥7.5% should receive moderate- or high-intensity statin therapy.

High-intensity statin therapies are atorvastatin (40–80 mg) or rosuvastatin (Crestor; 20–40 mg). Moderate-intensity statin therapies include atorvastatin (10–20 mg), rosuvastatin (5–10 mg), simvastatin (20–40 mg), pravastatin (40–80 mg), and several others.

With few exceptions, use of lipid-modifying drugs other than statins is discouraged.

Lifestyle modification is recommended for all patients, regardless of cholesterol-lowering drug therapy.

These guidelines use a new ten year risk calculator which includes both coronary events and stroke, and is only available as an Excel spreadsheet currently.

This is different to the calculators used in Australia, as per another discussion on this site.

Join the discussion as we prepare our POQ at this forum

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