JCL roundtable. The 2018 AHA/ACC/Multisociety Cholesterol Guidelines: Process and product
Lynne T Braun1, Joseph J Saseen2, Carl E Orringer3
1Rush College of Nursing and Medicine, Chicago, IL, USA.
Insights
The 2018 AHA/ACC Cholesterol Guidelines emphasize clinician-patient discussions and personalized risk assessment using various factors. They also outline strategies for LDL cholesterol reduction and non-statin therapy initiation.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Guidelines
Background:
- The National Lipid Association (NLA) Roundtable convened to discuss the development of the 2018 AHA/ACC/Multisociety Cholesterol Guidelines.
- These guidelines represent a significant update in cardiovascular risk assessment and lipid management.
Purpose of the Study:
- To provide insights into the process of creating the 2018 AHA/ACC/Multisociety Cholesterol Guidelines.
- To highlight key recommendations and personal perspectives on the finalized guidelines.
Main Methods:
- Discussion of the committee's approach to guideline development.
- Summarization of 10 key take-home messages for rapid communication.
- Emphasis on clinician-patient dialogue and personalized risk stratification.
Main Results:
- Incorporation of risk-enhancing factors (e.g., LDL-C ≥ 160 mg/dl, metabolic syndrome, CKD) for personalized risk assessment.
- Use of coronary artery calcium scoring in uncertain intermediate-risk cases.
- Defined thresholds for initiating non-statin LDL-lowering therapy in high-risk individuals and familial hypercholesterolemia.
- Consideration of cost-value assessment for novel therapies.
Conclusions:
- The guidelines promote shared decision-making and individualized treatment plans.
- Risk stratification is enhanced by incorporating novel factors and imaging.
- Management strategies address both traditional and advanced lipid-lowering therapies.
Abstract:
In this NLA Roundtable four members of the writing committee join the Editor to discuss the process of developing the AHA/ACC/Multisociety Cholesterol Guidelines, which were unveiled in November 2018. They also provide personal insights on the finished product. Highlights include 1) the committee's decision to summarize 10 take-home messages providing rapid communication of key points, 2) emphasis on clinician -patient discussion, which may bring up issues specific to women or other population groups at risk, 3) personalizing risk with risk-enhancing factors such as LDL-C ≥ 160 mg/dl, metabolic syndrome, chronic kidney disease, pre-eclampsia, premature menopause, high risk ethnicity, inflammatory diseases, hypertriglyceridemia and in selected cases, Lp(a), hs-CRP and apoB; 4) using coronary artery calcium scoring when a risk decision is uncertain in intermediate risk patients 5) monitoring for goals of moderate or intensive LDL cholesterol reduction, 6) thresholds for adding nonstatin LDL-lowering therapy in those at very high risk or for heterozygous familial hypercholesterolemia and 7) cost value assessment for expensive treatment.
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