2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults.

The ACC and the American Heart Association (AHA), in collaboration with the National Heart, Lung, and Blood Institute (NHLBI) and other specialty societies, released four guidelines focused on the assessment of cardiovascular risk, lifestyle modifications to reduce cardiovascular risk and management of elevated blood cholesterol and body weight in adults.

These four prevention guidelines were among five initially commissioned by NHLBI starting in 2008 and transitioned to the ACC and AHA in June 2013 as part of a collaborative arrangement to facilitate their completion and publication. A fifth guideline addressing hypertension will be initiated in early 2014. Each provides important updated guidance for primary care providers, nurses, pharmacists and specialty medicine providers on how best to manage care of individuals at risk for cardiovascular-related diseases based on the latest scientific evidence.

NLA Statement on the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

The American College of Cardiology and the American Heart Association released the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. The National Lipid Association (NLA) was invited to participate in this process and worked initially with the NHLBI and then eventually with the AHA and ACC as the guidelines were transitioned and finalized. We provided our comments but after multiple revisions, ultimately felt that the document presented - although important and constructive--does not go far enough to address gaps in clinical care and therefore decided not to endorse them as guidelines. We understand the constraints that the NHLBI panel had in limiting their review to only high quality randomized controlled trials but also believe that other important types of clinical evidence should not have been excluded. We also do not find evidence-based support for the Panel’s recommendation for removing LDL-C (and Non-HDL-C) treatment targets. We question the need to remove such important and well-known clinical performance metrics that have been so widely endorsed by the clinical community. Further we find there to be an absence of discussion regarding other therapeutic options for patients on high-dose statins but which still exhibit high residual risk and/or significantly elevated LDL-C levels. There also needs to be more discussion on managing special populations such as older patients above age 75, those with familial hypercholesterolemia, those who are statin-intolerant, and younger high risk patients under age 40.

The NLA understands and appreciates the considerable effort and professionalism that went into creating this document which should serve as an initial focal point for ongoing discussion. We have been invited and will participate fully in the next phase of guidelines development with the AHA and ACC, along with other stakeholder groups, to discuss further implementation options and considerations. Our goal is to contribute our vast expertise and experience to the next set of guidelines so that clinicians can better and more comprehensively manage their patients in both primary care and specialty practice. The NLA looks forward to a continued collaborative partnership with the ACC and the AHA to enhance these guidelines in the next phase.

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