Dyslipidemia 3: AHA 2013 Guideline

We return to the topic of dyslipidemia and examined the: “2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults” http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a

Previous episodes on statins can be found here.

Major differences between AHA 2013 guideline and CCS 2012 guideline:

CCS 2012 AHA 2013
Treatment Threshold
  • LR (FRS<10%): consider lifestyle only
  • IR (FRS 10-19%), if LDL <3.5mmol/L: consider lifestyle only
  • Optional alternate target and secondary tests reasonable
  • HR (FRS >20%), history of CVD, DM aged >40: statins
  • LDL >5 mmol/L: statins
  • CVD: statins
  • LDL > 4.9 mmol/L: statins
  • DM aged 40-75: statins
  • 10-year risk >7.5%: statins
Treatment Target
  • LDL >50% reduction
  • LDL < 2mmol/L for IR and HR groups
  • No target
  • Fixed dose statins based on initial risk assessment

Pooled Cohort Equations to estimate 10-year CVD risk: http://www.cardiosource.org/science-and-quality/practice-guidelines-and-quality-standards/2013-prevention-guideline-tools.aspx

Dr. McCormack’s discussion on patient centered EBM on KevinMD: http://www.kevinmd.com/blog/2013/12/cholesterol-guidelines-emphasize-patient-preference.html

(Originally published on January 25, 2014)