Study Discusses Paradigm Shift in Strategy to Lower Cholesterol
Based on current statistical trends, almost one-third of the population in the U.S. will die as a result of a heart attack or stroke associated with atherosclerotic cardiovascular disease (ASCVD). With major treatable causes of ASCVD including hypercholesterolemia, hypertension, diabetes and other comorbidities, guideline recommendations have been developed focusing on treatment strategies to reduce these risk factors.
In a state-of-the-art paper published Aug. 4 in the Journal of the American College of Cardiology, Sidney C. Smith, Jr., MD, and Scott M. Grundy, MD, PhD, review the recently issued "ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults." They explain that unlike previous guidelines, the new guideline endorses a paradigm shift in the strategy for reducing ASCVD events by lowering blood cholesterol. Instead of encouraging therapy to decrease low-density lipoprotein and non-high-density lipoprotein cholesterol to specific target levels, the new recommendations propose cholesterol-lowering treatment by implementing varying intensities of statin therapy without such targets. Reviewed evidence from randomized controlled trials showed a strong and consistent reduction in ASCVD clinical events in patients who were treated utilizing this method.
The guideline also delivers a new risk estimator for primary prevention decisions, including stroke outcomes and data on African Americans, which is designed to significantly increase the number of patients recommended for outcome-related benefits of any cholesterol-lowering therapy. While there is still a need for additional randomized controlled trial evidence regarding effective strategies to reduce ASCVD risk in women, in patients older than 75, in patients younger than 40, and in additional ethnic groups such as East Asian, South Asian and Hispanic, the updated parameters are designed to help achieve optimal care and reduce ASCVD risk.
The authors note that "current evidence base must be combined with clinical judgment and patient preference to achieve optimal care and reduce ASCVD risk." However, moving forward, more work is needed since "virtually no guidance is provided to the caregiver for how to adjust the guidelines to best fit the individual."
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