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Thursday, January 10, 2019
New cholesterol guidelines offer more personalized risk calculation, endorse nonstatin therapy
Still focusing on the bystander rather the the real problem.
Well shit, the whole problem is inflammation grabbing cholesterol
out of the bloodstream and packing it into plaque. Cholesterol has
never been the problem.
New,
anticipated cholesterol guidelines from the American Heart Association,
American College of Cardiology and 10 other societies recommend a
stepped approach including treatment with statins, ezetimibe and PCSK9
inhibitors in patients with prior CVD at very high risk for another CV
event.
The updated guidance also calls for more personalized risk assessment
than outlined in the previous version, which was published in 2013.
The guidelines are also notable for carving out a broader role for
coronary artery calcium scoring in patients in whom it is unclear
whether statin therapy should be initiated, returning LDL targets to
prominence in certain cases and adding emphasis on a heart-healthy
lifestyle, experts told Cardiology Today.
Keith C. Ferdinand
“I consider the 2018 cholesterol guidelines a step forward. They
emphasize, as previous guidelines have done but perhaps in a more
forward-thinking manner, the importance of a heart-healthy lifestyle,” Keith C. Ferdinand, MD, professor of medicine at Tulane University School of Medicine and Cardiology Today
Editorial Board Member, said in an interview. “They build into their
message not only adults who have high cholesterol but also young
individuals to prevent the development of atherosclerotic CVD (ASCVD).
Also of importance, many clinicians were somewhat dismayed and maybe
confused by the lack of the 2013 cholesterol guidelines having goals or
thresholds. But now, for specific patients, it helps clinicians target
their specific therapies in a little more concrete manner, such as LDL
lower than 70 mg/dL in high-risk patients and persons with diabetes.”
Steven E. Nissen, MD, from Cleveland Clinic, said the 2018
cholesterol guidelines endorse the idea that lower LDL is always better.Source: Cleveland Clinic; reprinted with permission.Steven E. Nissen, MD, chairman of the Robert and
Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland
Clinic’s Sydell and Arnold Miller Family Heart and Vascular Institute
and Cardiology Today Editorial Board Member, said the new guidelines address many of the shortcomings of the 2013 guidelines.
“The 2013 guidelines received a lot of criticism. What is interesting
about the new guidelines is that they have addressed many of those
concerns correctly and appropriately,” he told Cardiology Today.
“The authors are bringing back the idea of LDL targets; you should not
just give a statin and walk away. They are recommending more aggressive
treatment of patients with LDL greater than 70 mg/dL, using add-ons of
nonstatin therapies such as ezetimibe and PCSK9 inhibitors if necessary.
That is a big step forward. Many of us have believed for quite some
time that lower is better. The guidelines now acknowledge that.”
Role of nonstatin therapies
These are the first guidelines to endorse ezetimibe and the PCSK9
inhibitors alirocumab (Praluent, Sanofi/Regeneron) and evolocumab
(Repatha, Amgen) for use in certain patients, based on the results of
the IMPROVE-IT, FOURIER and ODYSSEY OUTCOMES trials.
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