Blood cholesterol LDL and non-HDL treatment goals: Difference between revisions
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==Overview== | ==Overview== | ||
No recommendations are made for or against specific | No recommendations are made for or against specific LDL-C or non-HDL-C goals for the [[ACC AHA guideline on the treatment of blood cholesterol primary prevention| | ||
primary prevention]] or [[ACC AHA guideline on the treatment of blood cholesterol secondary prevention|secondary prevention]] of atherosclerotic cardiovascular disease (ASCVD) given the lack of evidence on titration of cholesterol-lowering therapy to specific goals. | primary prevention]] or [[ACC AHA guideline on the treatment of blood cholesterol secondary prevention|secondary prevention]] of atherosclerotic cardiovascular disease (ASCVD), given the lack of evidence on the titration of cholesterol-lowering therapy to specific goals. | ||
==LDL and | == 2018 AHA ACC Guideline on the Management of Blood Cholesterol. Primary Prevention == | ||
=== Implementation === | |||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" | <nowiki>"</nowiki>'''1.''' Interventions focused on improving adherence to prescribed therapy are recommended for the management of adults with elevated cholesterol levels, including telephone reminders, calendar reminders, integrated multidisciplinary educational activities, and pharmacist-led interventions, such as simplification of the drug regimen to once-daily dosing''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Clinicians, health systems, and health plans should identify patients who are not receiving guideline-directed medical therapy and should facilitate the initiation of appropriate guideline-directed medical therapy, using multifaceted strategies to improve guideline implementation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''3.''' Before therapy is prescribed, a patient-clinician discussion should take place to promote shared decision-making and should include the potential for ASCVD risk-reduction benefit, adverse effects, drug-drug interactions, and patient preferences (''[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-NR]])'' <nowiki>"</nowiki> | |||
|} | |||
<ref name="pmid304233912">{{cite journal| author=Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 24 | pages= 3168-3209 | pmid=30423391 | doi=10.1016/j.jacc.2018.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423391 }}</ref> | |||
==2013 ACC AHA guideline on the treatment of blood cholesterol LDL and non-HDL treatment goals== | |||
There are few trials that were designed to define the optimal goals for LDL-C or non-HDL-C by titrating cholesterol-lowering therapy. In AIM-HIGH, the additional reduction in non-HDL–C levels with niacin therapy did not further reduce ASCVD risk in individuals treated to LDL–C levels of 40 to 80 mg/dL.<ref name="Boden-2011">{{Cite journal | last1 = Boden | first1 = WE. | last2 = Probstfield | first2 = JL. | last3 = Anderson | first3 = T. | last4 = Chaitman | first4 = BR. | last5 = Desvignes-Nickens | first5 = P. | last6 = Koprowicz | first6 = K. | last7 = McBride | first7 = R. | last8 = Teo | first8 = K. | last9 = Weintraub | first9 = W. | title = Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. | journal = N Engl J Med | volume = 365 | issue = 24 | pages = 2255-67 | month = Dec | year = 2011 | doi = 10.1056/NEJMoa1107579 | PMID = 22085343 }</ref> Therefore, no recommendations are made for or against specific LDL–C or non-HDL–C goals for the primary or secondary prevention of ASCVD due to the lack of evidence on titration of drug therapy to specific goals. | There are few trials that were designed to define the optimal goals for LDL-C or non-HDL-C by titrating cholesterol-lowering therapy. In AIM-HIGH, the additional reduction in non-HDL–C levels with niacin therapy did not further reduce ASCVD risk in individuals treated to LDL–C levels of 40 to 80 mg/dL.<ref name="Boden-2011">{{Cite journal | last1 = Boden | first1 = WE. | last2 = Probstfield | first2 = JL. | last3 = Anderson | first3 = T. | last4 = Chaitman | first4 = BR. | last5 = Desvignes-Nickens | first5 = P. | last6 = Koprowicz | first6 = K. | last7 = McBride | first7 = R. | last8 = Teo | first8 = K. | last9 = Weintraub | first9 = W. | title = Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. | journal = N Engl J Med | volume = 365 | issue = 24 | pages = 2255-67 | month = Dec | year = 2011 | doi = 10.1056/NEJMoa1107579 | PMID = 22085343 }</ref> Therefore, no recommendations are made for or against specific LDL–C or non-HDL–C goals for the primary or secondary prevention of ASCVD due to the lack of evidence on titration of drug therapy to specific goals. | ||
Latest revision as of 16:11, 2 December 2022
Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
No recommendations are made for or against specific LDL-C or non-HDL-C goals for the primary prevention or secondary prevention of atherosclerotic cardiovascular disease (ASCVD), given the lack of evidence on the titration of cholesterol-lowering therapy to specific goals.
2018 AHA ACC Guideline on the Management of Blood Cholesterol. Primary Prevention
Implementation
| Class I |
| "1. Interventions focused on improving adherence to prescribed therapy are recommended for the management of adults with elevated cholesterol levels, including telephone reminders, calendar reminders, integrated multidisciplinary educational activities, and pharmacist-led interventions, such as simplification of the drug regimen to once-daily dosing(Level of Evidence: A) " |
| "2. Clinicians, health systems, and health plans should identify patients who are not receiving guideline-directed medical therapy and should facilitate the initiation of appropriate guideline-directed medical therapy, using multifaceted strategies to improve guideline implementation (Level of Evidence: B-NR) " |
| "3. Before therapy is prescribed, a patient-clinician discussion should take place to promote shared decision-making and should include the potential for ASCVD risk-reduction benefit, adverse effects, drug-drug interactions, and patient preferences (Level of Evidence: B-NR) " |
2013 ACC AHA guideline on the treatment of blood cholesterol LDL and non-HDL treatment goals
There are few trials that were designed to define the optimal goals for LDL-C or non-HDL-C by titrating cholesterol-lowering therapy. In AIM-HIGH, the additional reduction in non-HDL–C levels with niacin therapy did not further reduce ASCVD risk in individuals treated to LDL–C levels of 40 to 80 mg/dL.[2] Therefore, no recommendations are made for or against specific LDL–C or non-HDL–C goals for the primary or secondary prevention of ASCVD due to the lack of evidence on titration of drug therapy to specific goals.
References
- ↑ Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS; et al. (2019). "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. 73 (24): 3168–3209. doi:10.1016/j.jacc.2018.11.002. PMID 30423391.
- ↑ {{Cite journal | last1 = Boden | first1 = WE. | last2 = Probstfield | first2 = JL. | last3 = Anderson | first3 = T. | last4 = Chaitman | first4 = BR. | last5 = Desvignes-Nickens | first5 = P. | last6 = Koprowicz | first6 = K. | last7 = McBride | first7 = R. | last8 = Teo | first8 = K. | last9 = Weintraub | first9 = W. | title = Niacin in patients with low HDL cholesterol levels receiving intensive statin therapy. | journal = N Engl J Med | volume = 365 | issue = 24 | pages = 2255-67 | month = Dec | year = 2011 | doi = 10.1056/NEJMoa1107579 | PMID = 22085343 }