2013 ACC/AHA guideline recommends fixed-dose strategies instead of targeted goals to lower blood cholesterol

The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines recently issued the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. This new guideline endorses a paradigm shift in strategies for reducing atherosclerotic cardiovascular disease (ASCVD) events by lowering blood cholesterol. Whereas previous guidelines focused on therapy to decrease low-density lipoprotein and non-high-density lipoprotein cholesterol to specific target levels, the new guideline instead proposes implementation of cholesterol-lowering treatment using evidenced-based intensity of statin therapy without such targets. The guideline also provides a new risk estimator for primary prevention decisions, including stroke outcomes and data on African Americans, which will significantly increase the number of patients recommended for outcome-related benefits of cholesterol-lowering therapy. The first section of this paper reviews the process by which the task force developed the new evidence-based guideline, the major findings and recommendations, and their implications. The second section primarily focuses on the question of how much low-density lipoprotein cholesterol should be lowered and on additional considerations in risk assessment.