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Title: 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

Author
item STONE, NEIL - Northwestern University
item ROBINSON, JENNIFER - University Of Iowa
item LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University
item MERZ, C. NOEL BAIREY - Cedars-Sinai Medical Center
item BLUM, CONRAD - Columbia University Medical Center
item ECKEL, ROBERT - University Of Colorado
item GOLDBERG, ANNE - Washington University
item GORDON, DAVID - University Of Oklahoma
item LEVY, DANIEL - National Institutes Of Health (NIH)
item LLOYD-JONES, DONALD - Northwestern University
item MCBRIDE, PATRICK - University Of Wisconsin
item SCHWARTZ, J SANFORD - University Of Pennsylvania
item SHERO, SUSAN - National Institutes Of Health (NIH)
item SMITH, SIDNEY - University Of North Carolina
item WATSON, KAROL - University Of California
item WILSON, PETER W F - Emory University

Submitted to: Circulation
Publication Type: Other
Publication Acceptance Date: 8/16/2013
Publication Date: 11/12/2013
Citation: Stone, N., Robinson, J., Lichtenstein, A.H., Merz, C., Blum, C.C., Eckel, R.H., Goldberg, A.C., Gordon, D., Levy, D., Lloyd-Jones, D.M., Mcbride, P., Schwartz, J., Shero, S.T., Smith, S.C., Watson, K., Wilson, P. 2013. 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. Circulation. 129(25 Suppl 2):S1-S45.

Interpretive Summary:

Technical Abstract: This guideline is based on the Full Panel Report which is provided as a data supplement to the guideline. The Full Panel Report contains background and additional material related to content, methodology, evidence synthesis, rationale and references and is supported by the NHLBI Systematic Evidence Review which can be found at (http://www.nhlbi.nih.gov/guidelines/cholesterol/ser/). The Expert Panel was charged with updating the clinical practice recommendations for the treatment of blood cholesterol levels to reduce atherosclerotic cardiovascular disease (ASCVD) risk using data from randomized controlled trials (RCTs) and systematic reviews and meta-analyses of RCTs. For this guideline, ASCVD includes coronary heart disease (CHD), stroke, and peripheral arterial disease, all of presumed atherosclerotic origin. These recommendations are intended to provide a strong evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men. By using RCT data to identify those most likely to benefit from cholesterol-lowering statin therapy, the recommendations will be of value to primary care clinicians as well as specialists concerned with ASCVD prevention. Importantly, the recommendations were designed to be easy to use in the clinical setting, facilitating the implementation of a strategy of risk assessment and treatment focused on the prevention of ASCVD. The present guideline is intended to address treatment of adults (=21 years of age) to complement the NHLBI cardiovascular health risk reduction guideline for children and adolescents (4). Other strategies for using drug therapy to reduce ASCVD events have been advocated, including treat-to-cholesterol target, lower cholesterol is better, and risk-based treatment approaches. However, only 1 approach has been evaluated in multiple RCTs – the use of fixed doses of cholesterol-lowering drugs to reduce ASCVD risk. Because the overwhelming body of evidence came from statin RCTs, the Expert Panel appropriately focused on these statin RCTs to develop evidence-based guidelines for the reduction of ASCVD risk. We recognize that this represents a significant departure from current strategies. This should not come as a surprise to clinicians. The recent guideline on heart failure has changed long-standing paradigms based on the evidence and this guideline is no exception (5). Future RCTs will be needed to determine the optimal treatment strategy to provide the greatest reduction in ASCVD events with best margin of safety.