Overview of 2013 American College of Cardiology/American Heart Association cholesterol guideline for reducing cardiovascular risk

Abstract

The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) Guideline for the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults represents a paradigm shift in how cardiovascular prevention guidelines are developed and how cholesterol is treated [1]. The National Heart, Lung and Blood Institute convened the Adult Treatment Panel IV in 2008 to update the ATP III guidelines. The updated guidelines were never intended to provide comprehensive recommendations for the identification, detection and treatment of lipid disorders. The updated guidelines are intended to provide focused recommendations for reducing the risk of atherosclerotic cardiovascular disease (ASCVD) events based on evidence from randomized controlled trials (RCTs). Therefore, the Guideline Pane undertook a rigorous systematic review of RCTs of cholesterol-lowering drug therapy that had ASCVD outcomes, and meta-analyses of these RCTs to address three critical questions important for clinical practice. The guideline development process adhered to most of the principles that were subsequently advocated by the Institute of Medicine for developing trustworthy guidelines [2]. The 2013 ACC/AHA cholesterol recommendations focus on using the appropriate intensity of statin therapy in those most likely to experience a net ASCVD risk-reduction benefit. By contrast, the previous ATP III guideline recommended treatment to specific low density lipoprotein cholesterol (LDL-C) and nonhigh density lipoprotein cholesterol (non-HDL-C) treatment goals. The major 2013 cholesterol recommendations highlighted below.