Year Released: 2013
Societies: American College of Cardiology/American Heart Association
Collaboration: National Heart, Lung, and Blood Institute
The AHA and ACC made evidence-based recommendations on how to better treat blood cholesterol in adults to reduce atherosclerotic cardiovascular risk (ASCVD).
Statin therapy initiation
The panel convened by the AHA and ACC found consistent evidence that supports the use of statins for the prevention of ASCVD in many higher-risk primary and all secondary prevention individuals without New York Heart Association class II to IV heart failure who were not receiving hemodialysis.
Physicians and patients, however, should have discussions before the initiation of statin therapy. The guidelines recommend that patients and physicians discuss the potential for ASCVD risk reduction, as well as adverse effects, drug-to-drug interactions and patient preferences.
The guidelines recommend the use of high-intensity statins in adults aged 75 years or younger who have no safety concerns, whereas patients older than 75 years or those with safety concerns should receive moderate-intensity statins.
Additionally, the guidelines recommend that for the prevention in individuals without clinical ASCVD or diabetes who have an LDL of 70 mg/dL to 189 mg/dL, the estimated absolute 10-year risk for ASCVD should be used to guide the initiation of statin therapy. The 10-year ASCVD risk should be estimated with the Pooled Cohort Equation.
The guidelines recommend emphasizing the importance of lifestyle modification, such as a heart-healthy diet, regular exercise habits and maintenance of a healthy weight. Lifestyle modification remains a crucial component of health promotion and ASCVD risk reduction, according to the guidelines.
The AHA/ACC acknowledge that lifestyle modifications have been recommended as background therapy in randomized controlled trials that assess cholesterol-lowering drug therapies. Additionally, the guidelines recommend individuals review the AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk for lifestyle recommendations.
The recommendations within this guideline focus on patient populations that are well-represented in randomized controlled trials or likely to have high-risk genetic conditions. As a result, the recommendations are designed to inform rather than replace clinical judgment.
However, as the panel indicates, there are other patient groups for which a robust evidence base is lacking but that may include some for whom statin treatment should be considered based on the potential for ASCVD benefits to exceed the risk for adverse events and drug-to-drug interactions.
Stone NJ, et al. J Am Coll Cardiol. 2014;doi:10.1016/j.jacc.2013.11.002.