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HelixTalk Episode #90 - HelixTalk’s Top 10 Recommendations from the 2018 ACC/AHA Lipid Guidelines

Date posted: January 22, 2019, 6:00 am

In this episode, we review some of the most important new recommendations from the 2018 ACC/AHA guidelines for the management of blood cholesterol.

 

Key Concepts

  1. Shared decision making (between a healthcare provider and a patient) and individualized clinical decision making are now heavily emphasized by the guidelines -- a big win!  An ASCVD 10-year risk above 7.5% does not mandate that a statin be added.
  2. “Very high risk” patients (multiple ASCVD events or one ASCVD event plus multiple risk factors) are the primary group that may be considered for ezetimibe or PCSK9 inhibitors if LDL is not below 70 mg/dL.  For almost all other patient groups, stick with statin therapy.
  3. “Risk enhancers” and the coronary artery calcium (CAC) score can be considered for primary prevention in patients with intermediate risk (ASCVD 7.5% to 20%) to decide whether to initiate a statin or not.

References

  • Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 8. pii: S0735-1097(18)39034-X. doi: 10.1016/j.jacc.2018.11.003. 
  • Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018 Nov 3. pii: S0735-1097(18)39033-8. doi: 10.1016/j.jacc.2018.11.002. 
  • Supplement to the 2018 Guidelines, specifically Table S8: https://www.ahajournals.org/action/downloadSupplement?doi=10.1161%2FCIR.0000000000000625&file=web+supplement.pdf