AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY GUIDELINES FOR MANAGEMENT OF DYSLIPIDEMIA AND PREVENTION OF CARDIOVASCULAR DISEASE - EXECUTIVE SUMMARYComplete Appendix to Guidelines available at http://journals.aace.com.
OBJECTIVE
The development of these guidelines is mandated by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs).


METHODS
Each Recommendation is based on a diligent review of the clinical evidence with transparent incorporation of subjective factors.


RESULTS
The Executive Summary of this document contains 87 Recommendations of which 45 are Grade A (51.7%), 18 are Grade B (20.7%), 15 are Grade C (17.2%), and 9 (10.3%) are Grade D. These detailed, evidence-based recommendations allow for nuance-based clinical decision making that addresses multiple aspects of real-world medical care. The evidence base presented in the subsequent Appendix provides relevant supporting information for Executive Summary Recommendations. This update contains 695 citations of which 202 (29.1 %) are evidence level (EL) 1 (strong), 137 (19.7%) are EL 2 (intermediate), 119 (17.1%) are EL 3 (weak), and 237 (34.1%) are EL 4 (no clinical evidence).


CONCLUSIONS
This CPG is a practical tool that endocrinologists, other healthcare professionals, regulatory bodies and health-related organizations can use to reduce the risks and consequences of dyslipidemia. It provides guidance on screening, risk assessment, and treatment recommendations for a range of patients with various lipid disorders. These recommendations emphasize the importance of treating low-density lipoprotein cholesterol (LDL-C) in some individuals to lower goals than previously recommended and support the measurement of coronary artery calcium scores and inflammatory markers to help stratify risk. Special consideration is given to patients with diabetes, familial hypercholesterolemia, women, and pediatric patients with dyslipidemia. Both clinical and cost-effectiveness data are provided to support treatment decisions.


BACKGROUND
A1C = hemoglobin A1C ACE = American College of Endocrinology ACS = acute coronary syndrome AHA = American Heart Association ASCVD = atherosclerotic cardiovascular disease ATP = Adult Treatment Panel apo = apolipoprotein BEL = best evidence level CKD = chronic kidney disease CPG = clinical practice guidelines CVA = cerebrovascular accident EL = evidence level FH = familial hypercholesterolemia HDL-C = high-density lipoprotein cholesterol HeFH = heterozygous familial hypercholesterolemia HIV = human immunodeficiency virus HoFH = homozygous familial hypercholesterolemia hsCRP = high-sensitivity C-reactive protein LDL-C = low-density lipoprotein cholesterol Lp-PLA2= lipoprotein-associated phospholipase A2MESA = Multi-Ethnic Study of Atherosclerosis MetS = metabolic syndrome MI = myocardial infarction NCEP = National Cholesterol Education Program PCOS = polycystic ovary syndrome PCSK9 = proprotein convertase subtilisin/kexin type 9 T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus TG = triglycerides VLDL-C = very low-density lipoprotein cholesterol.
Paul S
PS
Jellinger
Yehuda
Y
Handelsman
Paul D
PD
Rosenblit
Zachary T
ZT
Bloomgarden
Vivian A
VA
Fonseca
Alan J
AJ
Garber
George
G
Grunberger
Chris K
CK
Guerin
David S H
DSH
Bell
Jeffrey I
JI
Mechanick
Rachel
R
Pessah-Pollack
Kathleen
K
Wyne
Donald
D
Smith
Eliot A
EA
Brinton
Sergio
S
Fazio
Michael
M
Davidson
Farhad
F
Zangeneh
Michael A
MA
Bush
D000328:Adult; D002318:Cardiovascular Diseases / Q000191:economics / Q000517:prevention & control*; D002648:Child; D003362:Cost-Benefit Analysis; D003940:Diagnostic Techniques, Endocrine / Q000191:economics / Q000592:standards; D050171:Dyslipidemias / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D000072097:Endocrinologists / Q000458:organization & administration / Q000592:standards; D004704:Endocrinology / Q000458:organization & administration / Q000592:standards*; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000592:standards; D011322:Primary Prevention / Q000191:economics / Q000379:methods / Q000592:standards*; D012955:Societies, Medical / Q000458:organization & administration; D014481:United States