New cholesterol guidelines and primary prevention in women

Cardiovascular disease (CVD) remains the leading cause of death for women in the United States. The role of primary prevention of CVD is a necessary focus of healthcare, given the overall prevalence of CVD and its risk factors in women. In 2013, the American College of Cardiology and the American Heart Association released new guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk (ASCVD) in adults that were based on results of randomized controlled trials. These guidelines apply to both men and women. Achievement of a target cholesterol level is no longer part of the guidelines. Rather, the guidelines recommend an appropriate and fixed intensity of a statin based on calculation of an individual׳s risk of ASCVD or in diabetics or those with severely elevated LDL-C for primary prevention. The new guidelines emphasize statin therapy over other lipid-lowering therapy. The new guidelines are evidence-based, coming from randomized control trials that have clearly demonstrated improved outcomes using statin therapy in those with ASCVD and those at high risk of ASCVD, not based on LDL targets but rather LDL lowering. This evidence-based approach to ASCVD prevention should be used in women. There were no specific sex differences in the new guidelines, and the focus of this article is to provide the evidence to support the use of these guidelines in women.