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.

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Key Concepts from the 2013 ACC/AHA Lipid Guidelines

1. 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.
2. 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.
3. "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.
4. The following patient groups should be considered for statin therapy:
   1. Any clinical ASCVD (history of heart attack or stroke)
   2. LDL above 190 mg/dL
   3. Diabetics (type I or type II) aged 40-75 years with an LDL of at least 70 mg/dL
   4. 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
5. 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.
6. There are three statin intensities recommended by the guidelines:
   1. "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
   2. "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
   3. "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
7. 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.

More Information

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (Full text PDF)