The future of lipid guidelines

Factors influencing guideline development may result in paradigm shifts in treatment recommendations.

The 2013 American College of Cardiology/American Heart Association cholesterol guideline provides an example of how new methodology and findings from randomized clinical trials can result in a paradigm shift in the approach to cardiovascular prevention. This guideline moved away from a treat to cholesterol goal approach. Based on strong evidence of a net benefit in randomized clinical trials, statins were recommended to reduce atherosclerotic cardiovascular disease risk in four groups of patients most likely to benefit. In addition, improved risk prediction equations and shared decision-making were recommended for guiding statin initiation in primary prevention patients with LDL cholesterol ≤190 mg/dl. Future guidelines will address the role of nonstatins for cardiovascular prevention. Improved risk prediction in statin-treated patients with and without cardiovascular disease, estimation of the potential for net benefit, and shared decision-making should be integral components of the next guideline.

Guidelines will continue to evolve as new data accumulate. New treatment paradigms will be needed to optimize patient outcomes.