New guidelines urge wider use of cholesterol-lowering drugs to reduce heart attacks, strokes

Risk Factor	Units	Acceptable range of values	Optimal values
Sex	M (for males) or F (for females)	M or F
Age	years	20-79
Race	AA (for African Americans) or WH (for whites or others)	AA or WH
Total Cholesterol	mg/dL	130-320	170
HDL-Cholesterol	mg/dL	20-100	50
Systolic Blood Pressure	mm Hg	90-200	110
Treatment for High Blood Pressure (if SBP >120)	Y (for yes) or N (for no)	Y or N	N
Diabetes	Y (for yes) or N (for no)	Y or N	N
Smoker	Y (for yes) or N (for no)	Y or N	N

Risk formula: http://my.americanheart.org/cvriskcalculator

Guidelines on cholesterol: http://bit.ly/1j2hDpH

Lifestyle: http://bit.ly/16ZnV7e

Overweight: http://bit.ly/1bsdFG2

Risk Assessment: http://bit.ly/19hzaV9

Cholesterol info: http://tinyurl.com/2dtc5vy

Heart facts: http://circ.ahajournals.org/content/127/1/e6

Table 2. What’s New in the Guideline?*

Focus on ASCVD Risk Reduction: 4 statin benefit groups

• Based on a comprehensive set of data from RCTs that identified 4 statin benefit groups which focus

efforts to reduce ASCVD events in secondary and primary prevention.

• Identifies high-intensity and moderate-intensity statin therapy for use in secondary and primary

prevention.

A New Perspective on LDL–C and/or Non-HDL–C Treatment Goals

• The Expert Panel was unable to find RCT evidence to support continued use of specific LDL–C and/or

non-HDL–C treatment targets.

• The appropriate intensity of statin therapy should be used to reduce ASCVD risk in those most likely to

benefit.

• Nonstatin therapies do not provide acceptable ASCVD risk reduction benefits compared to their potential

for adverse effects in the routine prevention of ASCVD.

Global Risk Assessment for Primary Prevention

• This guideline recommends use of the new Pooled Cohort Equations to estimate 10-year ASCVD risk in

both white and black men and women.

• By more accurately identifying higher risk individuals for statin therapy, the guideline focuses statin

therapy on those most likely to benefit.

• It also indicates, based on RCT data, those high-risk groups that may not benefit.

• Before initiating statin therapy, this guideline recommends a discussion by clinician and patients.

Safety Recommendations

• This guideline used RCTs to identify important safety considerations in individuals receiving treatment

of blood cholesterol to reduce ASCVD risk.

• Using RCTs to determine statin adverse effects facilitates understanding of the net benefit from statin

therapy.

• Provides expert guidance on management of statin-associated adverse effects, including muscle

symptoms.

Role of Biomarkers and Noninvasive Tests

• Treatment decisions in selected individuals who are not included in the 4 statin benefit groups may be

informed by other factors as recommended by the Risk Assessment Work Group guideline.

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Stone NJ, et al.

2013 ACC/AHA Blood Cholesterol Guideline

Future Updates to the Blood Cholesterol Guideline

• This is a comprehensive guideline for the evidence-based treatment of blood cholesterol to reduce

ASCVD risk.

• Future updates will build on this foundation to provide expert guidance on the management of complex

lipid disorders and incorporate refinements in risk stratification based on critical review of emerging

data.

• RCTs comparing alternate treatment strategies are needed in order to inform future evidence-based

guidelines for the optimum ASCVD risk reduction approach.