title: Lipid Management Guidelines from the Departments of Veteran Affairs and Defense: A Critique.
abstract: In December 2014, the US Department of Veterans Affairs and Department of Defense (VA/DoD) published an independent clinical practice guideline for the management of dyslipidemia and cardiovascular disease risk, adding to the myriad of recently published guidelines on this topic. The VA/DoD guidelines differ from major US guidelines published by the American College of Cardiology/American Heart Association in 2013 in the following ways: recommending moderate-intensity statins for the majority of patients with statin indications regardless of atherosclerotic cardiovascular disease risk; advocating for limited on-treatment lipid monitoring; and deemphasizing ancillary data, such as coronary artery calcium testing, to improve atherosclerotic cardiovascular disease risk estimation. In the context of manifold treatment recommendations from numerous guideline committees, the VA/DoD recommendations may generate further confusion and mixed messages among healthcare providers about the optimal treatment of dyslipidemia. In this review, we critically appraise the VA/DoD recommendations with a focus on the evidence base for each area where the VA/DoD guidelines differ from the American College of Cardiology/American Heart Association guidelines. We also call for harmonization of lipid treatment guidelines to ensure high-quality and consistent care for patients with, and at risk for, atherosclerotic cardiovascular disease.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Bennet
authors.affiliation: Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Md.
authors.forename: Chanukya R
authors.initials: CR
authors.lastname: Dahagam
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Seth S
authors.initials: SS
authors.lastname: Martin
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
authors.forename: Erin D
authors.initials: ED
authors.lastname: Michos
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: jmcevoy1@jhmi.edu.
authors.forename: John W
authors.initials: JW
authors.lastname: McEvoy
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002118:Calcium / Q000032:analysis; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003331:Coronary Vessels / Q000737:chemistry; D050171:Dyslipidemias / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D008055:Lipids / Q000097:blood; D017410:Practice Guidelines as Topic; D014481:United States; D059030:United States Department of Defense / Q000592:standards*; D014493:United States Department of Veterans Affairs / Q000592:standards*
chemical_list: D015415:Biomarkers; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002118:Calcium
keywords: Atherosclerotic cardiovascular disease; Coronary artery calcium; Dyslipidemia; Guidelines; Veterans Affairs