2. When an initial nonfasting lipid profile reveals a triglyceride level of 400 mg per dL (4.5 mmol per L) or greater, a repeat lipid profile should be obtained to assess fasting triglyceride and baseline LDL-C levels in adults 20 years and older. Yes, Guideline developed by participants without relevant financial ties to industry? Editor’s Note: Similar to the 2013 ACC/AHA cholesterol guideline, this guideline has some utility for family physicians but is limited by several recommendations that will be challenging to implement and lack patient-oriented evidence. High-quality evidence from RCTs recommends that patients 40 to 75 years of age without diabetes who are at intermediate risk with LDL-C levels of 70 to 189 mg per dL (1.81 to 4.90 mmol per L) should be treated with a moderate-intensity statin. With FMX On Demand, you can access recorded FMX sessions led by family medicine experts, and earn up to 155 enduring CME credits. Also, it may be beneficial to treat patients 20 to 75 years of age who have an LDL-C level of 190 mg per dL or greater with ezetimibe if they have not been able to achieve a 50% reduction in LDL-C level while receiving maximally tolerated statin therapy and/or still have an LDL-C level of at least 100 mg per dL (2.59 mmol per L). Given the imprecision in risk estimates, eliciting patients’ values and preferences regarding the potential benefits and harms of statins and other lipid-lowering agents remains essential to treatment decisions.—Kenny Lin, MD, MPH, AFP Deputy Editor, Guideline source: American College of Cardiology/American Heart Association, Systematic literature search described? Based on high-quality RCTs, fasting lipid measurement should be repeated four to 12 weeks after starting the statin or making a dose adjustment to assess adherence and response to LDL-C–lowering medications and lifestyle changes. The guideline on Management of Blood Cholesterol was developed by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and was categorized as Affirmation of Value by the American Academy of Family Physicians. For example, the guideline recommends periodic lipid monitoring in patients receiving therapy, even though randomized trials generally prescribed fixed statin doses rather than titrating to LDL-C percentage reductions or threshold levels. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. Based on moderate-quality evidence from RCTs, maximally tolerated statin therapy is recommended for patients 20 to 75 years of age with an LDL-C level of 190 mg per dL (4.92 mmol per L) or greater. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. This guideline was reviewed by the AAFP and received an Affirmation of Value: https://doi.org/10.1016/j.jacc.2018.11.003, https://www.aafp.org/patient-care/clinical-recommendations/all/cholesterol.html, Risks of Elective Labor Induction vs. Expectant Management, Denosumab for Reducing Risk of Fractures in Postmenopausal Women. Contact 2019 May 1;99(9):589-591. Copyright © 2020 American Academy of Family Physicians. If the CAC score is zero, statin therapy should be withheld or delayed unless the patient is a cigarette smoker, has diabetes, or has a strong family history of premature ASCVD. In patients with clinical ASCVD, reduce low-density lipoprotein cholesterol (LDL-C) with high-intensity statin … Get Permissions, Access the latest issue of American Family Physician. Finally, the ACC/AHA did not update the Pooled Cohort Equations risk assessment tool, despite widespread recognition that it can significantly overestimate 10-year risk of myocardial infarction and stroke. A healthy lifestyle … This guideline is a full update of the 2013 ACC/AHA cholesterol guideline. Adults 40-75 years of age with diabetes mellitus and an LDL-C 70-189 mg/dL should be treated with moderate-intensity statin therapy.
2020 2019 guideline on the management of blood cholesterol