2013 ACC/AHA Guidelines: Blood Cholesterol And Assessment of Cardiovascular Risk Elena Kuklina, MD,...
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Transcript of 2013 ACC/AHA Guidelines: Blood Cholesterol And Assessment of Cardiovascular Risk Elena Kuklina, MD,...
2013 ACC/AHA Guidelines:Blood Cholesterol And
Assessment of Cardiovascular Risk
Elena Kuklina, MD, Ph.D.Senior Service Fellow
State Grantee Webinar, Hypertension, Cholesterol and Sodium Guidelines: Implications for
Cardiovascular Health February 12, 2014
National Center for Chronic Disease Prevention and Health Promotion
Division for Heart Disease and Stroke Prevention
Background
ACC/AHA published new cholesterol and cardiovascular risk assessment guidelines in 2013. 1
This is an overview of the 2013 ACC/AHA guidelines and a comparison to preceding guidelines.
1. Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November 12 2013]. Circulation. 2013. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437741.48606.98.citation. Accessed February 3, 2014.
ATP III Lipid and Lipoprotein Classification
(The “Old Familiar Classification”)
LDL Cholesterol (mg/dL)
<100 Optimal100–129 Near optimal/above optimal130–159 Borderline high160–189 High190 Very high
Old vs. New: Lifestyle Modification
Old guidelines: Diet: low fat and
low cholesterol
New guidelines:Diet: healthy patternDASH, USDA , AHA DietCalorie requirements, personal and cultural preferences, and nutrition therapy for other medical conditions
regular exercise habits avoidance of tobacco products maintenance of a healthy weight
Old vs. New: Statin Eligibility
Old NewAge Statin eligible
groups
1 ≥21 years Clinical CVD
2 ≥21 years LDL-C ≥190 mg/dl
3 40-75 years +LDL-C 70-189 mg/dl
Diabetes
4 40-75 years + LDL-C 70-189 mg/dL
High CVD risk
≥7.5%, 10 years, CHD or stroke
Determining Risk for the 4th Group
New Pooled Cohort Equations to estimate 10-year risk Adults 20-79 years of age who are free from ASCVD 4 racially and geographically diverse cohorts ASCVD risk: heart disease and stroke Calculated from sex, age, race, total cholesterol, HDL
cholesterol, systolic blood pressure, and whether on treatment for high blood pressure, has diabetes, or is a smoker
See Flowchart (addendum)
New: Classification of Statin Intensity
Intensity of statin therapy: is defined as a daily dose that lowers LDL-C by
High-intensity: by 50%
Moderate-intensity: by 30% to <50%
New: Intensity Instead of Levels
What about the Rest?
There are people who may benefit from statin therapy who do not fall into one of the four groups.
As with other guidelines, clinicians may use their judgment in considering other factors such as:• family history of ASCVD. biomarkers such as C - reactive protein. ankle-brachial index, etc.
Summary
Statin is the first line therapy. Statin eligible groups based on benefit, not only on the LDL-C
measurement. Treatment is based on statin intensity instead of specific
treatment goals for blood cholesterol. New global risk assessment tool.
Healthy Dietary Patterns (servings per day unless specified) (2000 kcal)
Implications
High cholesterol is a major and controllable risk factor for heart attacks and strokes.
One goal of the ACC/AHA guidelines is to better identify and focus statin therapy on those who are most at risk for (or have) ASCVD.
Implications
We have much room for improvement for increasing the level of healthy lifestyles and statin therapy even among those most at risk.
We can use the guidelines to identify those who do not yet know they are at risk, and increase healthy lifestyle choices and statin therapy for those who are.
Program Considerations
New performance measures for cholesterol are in the development phase.
Right now, we can: Increase adaptation of healthy lifestyle and levels statin
therapy for those who do know they are at risk. Help them adhere to that therapy for the rest of their longer
lives.
Sources
Goff DC, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November 12 2013]. Circulation. 2013. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437741.48606.98.citation. Accessed February 3, 2014.
Stone NJ, Robinson J, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November 12 2013]. Circulation. 2013. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.citation. Accessed February 3, 2014.
Journal of American College of Cardiology. 2013. http://www.sciencedirect.com/science/article/pii/S0735109713060282. Accessed February 3, 2014
Education materials for patients
“Getting Healthy” by AHA: https://www.heart.org/HEARTORG/GettingHealthy/GettingHealthy_UCM_001078_SubHomePage.jsp
“Chose my plate” by USDA: http://www.choosemyplate.gov/
“Lowering your blood pressure with DASH” by NIH” https://www.nhlbi.nih.gov/health/health-topics/topics/dash/
Thank you!
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Chronic Disease Prevention and Health PromotionDivision for Heart Disease and Stroke Prevention