Cholesterol: The new guidelines
Ann K. McCullough
Northern Illinois University
There are 71 million American adults that have elevated low-density lipoproteins (LDL) cholesterol and only 33% of adults with high LDL’s are being treated (CDC, 2012). Dyslipidemia is a major risk factor for coronary artery disease (CAD) and it has shown to be a contributing factor for CAD. An estimated 785,000 Americans will have a new CAD event and approximately 470,000 will have a recurrent attack. The cost of CAD is astounding and is estimated at $172 billion annually (Heidenreich, el. al., 2011). Cardiovascular disease (CVD) is the leading cause of death in the United States (US) and is ...view middle of the document...
The new guidelines document a major shift in the treatment of LDL cholesterol and reducing the risk of atherosclerotic cardiovascular disease (ASCVD) in adults.
The AHA has created a set of impact goals for 2020 and one of those goals was to improve the cardiovascular health of all Americans by 20% while reducing the deaths from CVD and stroke by 20% (Go, et. al., 2013). The new cholesterol screening guidelines from the ACC/AHA were created to help meet that goal. It is estimated that in 2030, 40.5% of the US population will have some form of CVD thus making primary prevention at the forefront of care (Heidenreich, el. al., 2011). Through the use of primary prevention many patients will be prescribed a statin medication to reduce their risk of ASCVD. It is imperative that the primary care provider stresses the importance of lifestyle modification including adhering to a heart healthy diet, regular exercise, avoiding tobacco products, and maintaining a healthy weight. These modifications remain a critical component of health promotion and ASCVD risk reduction.
The ACC/AHA guidelines used high-quality clinical trial evidence to show the benefits and/or harms of statin use do not vary based on a person LDL level. The new guidelines have created many controversies and one professional organization; the American Association of Clinical Endocrinologist (AACE) doesn’t support the new guidelines.
The ACC/AHA vs. AACE Guidelines
According to the ACC/AHA guidelines there is no longer a target specific LDL cholesterol level, but recommend lipid-lowering therapies of varying intensity based on the patients predicted risk of cardiovascular events or to reduce the ASCVD risk. Implementation of the new guidelines would result in millions more American’s receiving high-potency statins. The guidelines emphasize that individuals where statin therapy is indicated prove that the benefits of reducing heart attack, stroke, and cardiovascular death significantly outweigh the risks of developing diabetes or myopathy (Ridker & Cook, 2013). The AACE agrees that the use of statins is the treatment of choice for patients with dyslipidemia however they disagree with the removal of LDL cholesterol goals and that statin monotherapy is sufficient for all at-risk-patients (AACE, 2013).
The new guidelines have four treatment groups that include: individuals with clinical ASCVD, individuals with LDL-cholesterol levels greater or equal to 190 mg/dL, such as those with familiar hypercholesterolemia, individuals with diabetes aged 40-75 years old with LDL-cholesterol levels between 70 and 189 mg/dL and without evidence of ASCVD, and individuals without evidence of cardiovascular disease or diabetes but who have LDL-cholesterol levels between 70 and 189 mg/dL and a 10-year risk of atherosclerotic cardiovascular disease exceeding 7.5% (O’Riordan, 2014). These four treatment groups should be treated with statins. The AACE believes that many patients are...