2018 Cholesterol Clinical Practice Guidelines: Synopsis of the 2018 American Heart Association/American College of...

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Practice Guidelines

Background:

• The American Heart Association and American College of Cardiology (AHA/ACC) issued new clinical practice guidelines in November 2018 for cholesterol management.
• These guidelines were developed alongside a risk assessment report focused on the primary prevention of atherosclerotic cardiovascular disease (ASCVD).

Purpose of the Study:

• To provide updated recommendations for cholesterol management and ASCVD prevention based on systematic reviews and meta-analyses.
• To outline strategies for both primary and secondary prevention of ASCVD, including lifestyle modifications and pharmacological interventions.

Main Methods:

• Systematic reviews and meta-analyses of randomized controlled trials (RCTs) were conducted by an expert panel to evaluate cardiovascular outcomes.
• High-quality observational studies were utilized for ASCVD risk estimation.
• RCT evidence on the benefits and risks of adding nonstatin medications to statin therapy was reviewed.

Main Results:

• The guideline promotes a heart-healthy lifestyle from childhood to reduce lifetime ASCVD risk.
• For secondary prevention, very high-risk patients may benefit from adding ezetimibe or PCSK9 inhibitors to statin therapy.
• In primary prevention, clinician-patient risk discussions are crucial, with risk-enhancing factors and coronary artery calcium testing aiding decisions for intermediate-risk patients.

Conclusions:

• The updated guideline emphasizes percentage reduction in low-density lipoprotein cholesterol and long-term monitoring.
• Nonfasting lipid measurements are now permitted to simplify monitoring.
• The guidelines represent a significant update from the 2013 recommendations, incorporating new evidence and approaches to ASCVD prevention and management.