Hyperlipidemia: An Evidence-based Review of Current Guidelines

Cholesterol treatment guidelines have evolved in the United States from the 1988 Adult Treatment Panel (ATP) I, the ATP II guidelines, ATP III guidelines, the 2013 American College of Cardiology/American Heart Association guidelines, to the most recent 2016 recommendations from the United States Protective Services Task Force. The use of statins to treat hyperlipidemia has been widely accepted and recommended in adults aged 40-75 years old with at least one risk factor and a calculated 10-year cardiovascular disease risk of 10%. However, statin use is associated with myalgias, myopathy, musculoskeletal injury, liver injury, and increased diabetes risk. The evidence for non-statin treatments is mixed. Bile acid sequestrants and ezetimibe reduce cardiovascular events. There is no evidence that the addition of any fibric acid derivative to a statin improves cardiovascular outcomes. Available evidence suggests that the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme inhibitors likely leads to little or no difference in mortality despite lowering lipid levels.