JCL roundtable. The 2018 AHA/ACC/Multisociety Cholesterol Guidelines: Process and product

J Clin Lipidol. 2019 May-Jun;13(3):345-355. doi: 10.1016/j.jacl.2019.05.008.

Abstract

In this NLA Roundtable four members of the writing committee join the Editor to discuss the process of developing the AHA/ACC/Multisociety Cholesterol Guidelines, which were unveiled in November 2018. They also provide personal insights on the finished product. Highlights include 1) the committee's decision to summarize 10 take-home messages providing rapid communication of key points, 2) emphasis on clinician -patient discussion, which may bring up issues specific to women or other population groups at risk, 3) personalizing risk with risk-enhancing factors such as LDL-C ≥ 160 mg/dl, metabolic syndrome, chronic kidney disease, pre-eclampsia, premature menopause, high risk ethnicity, inflammatory diseases, hypertriglyceridemia and in selected cases, Lp(a), hs-CRP and apoB; 4) using coronary artery calcium scoring when a risk decision is uncertain in intermediate risk patients 5) monitoring for goals of moderate or intensive LDL cholesterol reduction, 6) thresholds for adding nonstatin LDL-lowering therapy in those at very high risk or for heterozygous familial hypercholesterolemia and 7) cost value assessment for expensive treatment.

Keywords: Cholesterol guidelines; Coronary calcium scoring; Cost value assessment; Evidence-based medicine; Lipid clinical practice; Risk-enhancing factors.

MeSH terms

  • Cholesterol / metabolism*
  • Guidelines as Topic*
  • Humans
  • Hyperlipoproteinemia Type II / epidemiology
  • Hyperlipoproteinemia Type II / metabolism
  • Risk Factors
  • Societies, Medical*

Substances

  • Cholesterol