ACC/AHA guideline on the secondary prevention of hypercholestrolemia: Difference between revisions

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==Overview==
===2013 ACC AHA guideline on the treatment of blood cholesterol secondary prevention===
Individuals with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death and a growing body of evidences shows that high-intensity statin therapy reduces ASCVD events more than moderate-intensity statin therapy in individuals with clinical ASCVD.
===Secondary Prevention===
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''High-intensity statin therapy should be initiated or continued as first-line therapy in women and men ≤75 years of age who have clinical ASCVD, unless contraindicated.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|Level of Evidence: A]])''<nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2. '''In individuals with clinical ASCVD* in whom high-intensity statin therapy would otherwise be used, when high-intensity statin therapy is contraindicated† or when characteristics predisposing to statin-associated adverse effects are present, moderate-intensity statin should be used as the second option if tolerated.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|Level of Evidence: A]])''<nowiki>"</nowiki>
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==Secondary Prevention==
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* High-intensity statin therapy should be initiated for adults ≤75 years of age with clinical ASCVD who are not receiving statin therapy or the intensity should be increased in those receiving a low- or moderate-intensity statin, unless they have a history of intolerance to high-intensity statin therapy or other characteristics that may influence safety.  
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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| bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1. '''In individuals with clinical ASCVD >75 years of age, it is reasonable to evaluate the potential for ASCVD risk-reduction benefits and for adverse effects, drug-drug interactions and to consider patient preferences, when initiating a moderate- or high-intensity statin. It is reasonable to continue statin therapy in those who are tolerating it.''([[ACC AHA guidelines classification scheme#Classification of Recommendations|''Level of Evidence: C'']])''<nowiki>"</nowiki>
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* In individuals with clinical ASCVD in whom high-intensity statin therapy would otherwise be used, when either high-intensity statin therapy is contraindicated or when characteristics predisposing to statin- associated adverse effects are present, moderate-intensity statin should be used as the second option, if tolerated.
===Initiating and Management of Statin Therapy in Individuals with Clinical ASCVD===
 
* The use of statin therapy should be individualized in persons >75 years of age with clinical ASCVD, based on the potential for ASCVD risk reduction benefits, the potential for adverse effects and drug-drug interactions, and patient preferences. It is considered reasonable to continue statin therapy in persons >75 years of age who have clinical ASCVD and are tolerating statin therapy. Moderate-intensity statin therapy should be considered for individuals >75 years of age with clinical ASCVD.
 
==Initiating and Management of Statin Therapy in Individuals with Clinical ASCVD==
[[Image:ACCAHA cholesterol treatment ASCVD.jpg|800px]]
[[Image:ACCAHA cholesterol treatment ASCVD.jpg|800px]]


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==References==
==References==
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{{Reflist|2}}
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Latest revision as of 14:34, 27 February 2018

Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2013 ACC AHA guideline on the treatment of blood cholesterol secondary prevention

Secondary Prevention

Class I
"1. High-intensity statin therapy should be initiated or continued as first-line therapy in women and men ≤75 years of age who have clinical ASCVD, unless contraindicated.(Level of Evidence: A)"
"2. In individuals with clinical ASCVD* in whom high-intensity statin therapy would otherwise be used, when high-intensity statin therapy is contraindicated† or when characteristics predisposing to statin-associated adverse effects are present, moderate-intensity statin should be used as the second option if tolerated.(Level of Evidence: A)"
Class IIa
"1. In individuals with clinical ASCVD >75 years of age, it is reasonable to evaluate the potential for ASCVD risk-reduction benefits and for adverse effects, drug-drug interactions and to consider patient preferences, when initiating a moderate- or high-intensity statin. It is reasonable to continue statin therapy in those who are tolerating it.(Level of Evidence: C)"

Initiating and Management of Statin Therapy in Individuals with Clinical ASCVD

Clinical ASCVD is defined as acute coronary syndromes or history of MI, stable or unstable angina, coronary revascularization, stroke, or TIA presumed to be of atherosclerotic origin, and peripheral arterial disease or revascularization.

References


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