College of Pharmacy
HelixTalk Episode #1 - 2013 ACC/AHA Lipid Guidelines
Date posted: April 8, 2014, 6:00 am
In this episode, we discuss the new, rebranded podcast (HelixTalk) and review the new ACC/AHA 2013 lipid guidelines.
Key Concepts from the 2013 ACC/AHA Lipid Guidelines
- LDL is viewed as a risk factor (to predict risk of future heart attack or stroke). LDL "goals" or "targets" are no longer recommended as these were largely based on association rather than causation.
- Statin therapy is the treatment of choice to reduce the risk of ASCVD (atherosclerotic cardiovascular disease -- heart attacks and stroke). Statins both improve the surrogate serum lipid values (like LDL) and improve the clinical endpoints of heart attack and stroke.
- "Non-statin" lipid therapies (including fibrates, niacin, bile acid sequestrants, ezetimibe, and omega-3 fish oil) do tend to improve surrogate endpoints (like LDL or triglycerides) but do not have robust data showing a clinical benefit in reducing the risk of ASCVD. These "non-statin" therapies should not be recommended for routine management, but may be used for statin-intolerant patients, mixed dyslipidemias, or as an adjunct to statin therapy.
- The following patient groups should be considered for statin therapy:
- Any clinical ASCVD (history of heart attack or stroke)
- LDL above 190 mg/dL
- Diabetics (type I or type II) aged 40-75 years with an LDL of at least 70 mg/dL
- Any patient aged 40-75 years old with an LDL of at least 70 mg/dL and an ASCVD risk score of 7.5% or greater
- Initiation of statin therapy, especially for primary prevention, should be a discussion between a patient and healthcare provider. An ASCVD risk above 7.5% does not necessarily "require" the use of a statin.
- There are three statin intensities recommended by the guidelines:
- "High intensity" (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
- For those less than 75 years old with clinical ASCVD (previous heart attack or stroke)
- For those with LDL above 190 mg/dL
- For diabetics 40-75 years old with an ASCVD risk above 7.5% and LDL above 70 mg/dL
- "Moderate-to-high intensity" (see Table 5 in guidelines for list of statins):
- For non-diabetics 40-75 years old with an ASCVD risk above 7.5% and LDL above 70 mg/dL
- "Moderate intensity" (see Table 5 in guidelines for list of statins):
- Those older than 75 years of age with clinical ASCVD (previous heart attack or stroke)
- Those indicated for a high intensity statin but are intolerant due to side effects
- Diabetics aged 40-75 years old with an ASCVD risk below 7.5% and an LDL above 70 mg/dL
- "High intensity" (atorvastatin 40-80 mg or rosuvastatin 20-40 mg)
- The "ASCVD risk" is produced using an online calculator to estimate the risk of a heart attack or stroke within the next 10 years. The ASCVD model is considered by the ACC/AHA guidelines to be an upgrade of the older Framingham risk calculation.