Related Experiment Video
Updated: Jan 26, 2026
High-throughput Nitrobenzoxadiazole-labeled Cholesterol Efflux Assay
Published on: January 7, 2019
The 2018 Cholesterol Management Guidelines: Topics in Secondary ASCVD Prevention Clinicians Need to Know
Xiaoming Jia1, Mahmoud Al Rifai2,3, Yochai Birnbaum4
1Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Insights
New guidelines emphasize using ezetimibe and PCSK9 inhibitors alongside statins for secondary atherosclerotic cardiovascular disease (ASCVD) prevention in high-risk patients. These therapies effectively lower LDL cholesterol and reduce ASCVD event risk.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacology
Background:
- The 2018 ACC/AHA guidelines update cholesterol management for atherosclerotic cardiovascular disease (ASCVD) prevention.
- Contemporary evidence from trials on non-statin therapies is incorporated.
Purpose of the Study:
- To review key aspects of the 2018 ACC/AHA guidelines concerning secondary ASCVD prevention.
- To highlight updated recommendations for managing serum cholesterol.
Main Methods:
- Review of recent large randomized control trials (RCTs) involving ezetimibe and PCSK9 inhibitors (evolocumab, alirocumab).
- Analysis of the 2018 ACC/AHA Multisociety cholesterol guidelines.
Main Results:
- Ezetimibe and PCSK9 inhibitors demonstrate efficacy in reducing ASCVD events in patients with existing ASCVD.
- Guidelines recommend risk stratification to identify very-high-risk patients who benefit most from non-statin addition.
- High-intensity statins remain first-line; ezetimibe and PCSK9 inhibitors are options for residual risk management.
Conclusions:
- Updated guidelines integrate evidence for ezetimibe and PCSK9 inhibitors in secondary ASCVD prevention.
- Risk stratification is crucial for optimizing non-statin therapy selection.
- Non-statin agents are valuable for patients with very-high risk of recurrent ASCVD events on maximally tolerated statins.
Purpose Of Review:
The 2018 ACC/AHA Multisociety blood cholesterol guidelines provide updated recommendations based on contemporary evidence on the management of serum cholesterol for the prevention of atherosclerotic cardiovascular disease (ASCVD) events. This review discusses clinically important topics in the new guidelines related to secondary ASCVD prevention.
Recent Findings:
Since the 2013 ACC/AHA blood cholesterol guidelines, several large randomized control trials involving ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab) have been published. The trials provided evidence that these non-statin, LDL-cholesterol lowering agents are efficacious in reducing risk for ASCVD events in patients with clinical ASCVD. The 2018 guidelines incorporate these new findings into updated clinical recommendations on therapeutic strategies related to the use of ezetimibe and PCSK9 inhibitors. The guidelines also recommend risk stratification of secondary prevention patients to identify those at very high-risk of ASCVD events as these patients would derive the most absolute risk reduction from the addition of non-statin therapies. While high-intensity statins remain the first-line treatment to prevent recurrent ASCVD events in secondary prevention patients, ezetimibe and PCSK9 inhibitors are evidence-based non-statin agents that can be used when residual on top of maximally tolerated statin therapy in patients deemed to be at very-high risk of recurrent ASCVD events.
Related Concept Videos
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:23Stress Prevention and Stress Management Techniques II
Type A Personality: Driven and Easily Stressed
Individuals with Type A personalities are often highly competitive and ambitious and operate with a strong sense of urgency. Commonly labeled as...
01:26Stress Prevention and Stress Management Techniques I
Conscientiousness
Conscientious individuals tend to be organized, responsible, and disciplined. They prioritize completing tasks and following structured routines,...
01:28Stress Prevention and Stress Management Techniques V
01:30Stress Prevention and Stress Management Techniques VI
Motivation and Self-Determination
Motivation, the driving force behind behavior, plays a pivotal role at every stage of the change process. The research...
01:26Stress Prevention and Stress Management Techniques IV