title: 2013 ACC/AHA guideline recommends fixed-dose strategies instead of targeted goals to lower blood cholesterol.
abstract: The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines recently issued the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. This new guideline endorses a paradigm shift in strategies for reducing atherosclerotic cardiovascular disease (ASCVD) events by lowering blood cholesterol. Whereas previous guidelines focused on therapy to decrease low-density lipoprotein and non-high-density lipoprotein cholesterol to specific target levels, the new guideline instead proposes implementation of cholesterol-lowering treatment using evidenced-based intensity of statin therapy without such targets. The guideline also provides a new risk estimator for primary prevention decisions, including stroke outcomes and data on African Americans, which will significantly increase the number of patients recommended for outcome-related benefits of cholesterol-lowering therapy. The first section of this paper reviews the process by which the task force developed the new evidence-based guideline, the major findings and recommendations, and their implications. The second section primarily focuses on the question of how much low-density lipoprotein cholesterol should be lowered and on additional considerations in risk assessment.
authors.affiliation: Center for Cardiovascular Science and Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: scs@med.unc.edu.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: University of Texas, Southwestern Medical Center and VA Medical Center, Dallas, Texas. Electronic address: scott.grundy@utsouthwestern.edu.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Grundy
mesh_terms: D026683:Advisory Committees; D000572:American Heart Association; D002309:Cardiology / Q000592:standards*; D002784:Cholesterol / Q000097:blood*; D016503:Drug Delivery Systems / Q000379:methods / Q000592:standards*; D006040:Goals; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D017410:Practice Guidelines as Topic / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards; D014481:United States
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: LDL; atherosclerosis; cardiovascular diseases; cholesterol; hydroxymethylglutaryl-CoA reductase inhibitors; lipoproteins; risk factors; risk assessment