2013 ACC/AHA Lipid Guidelines: Mind the Gaps
The recently published 2013 ACC/AHA guidelines for the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk seem to have various implementation problems and have already initiated an intense debate. These guidelines identify 4 high-risk groups who could benefit from statins, patients with pre-existing atherosclerotic cardiovascular disease (CVD); people with familial (heterozygous) hypercholesterolemia, as evidenced by an LDL-cholesterol (LDL-C) of >190 mg/dl; diabetic patients aged 40-75; and people aged 40-75 with at least a 7.5% risk of developing CVD in the next decade, according to a formula described in the guidelines. In contrast to all other guidelines for the management of dyslipidemia, the 2013 ACC/AHA guidelines do not recommend specific LDL-C targets. Instead, they propose a 30-50% reduction in LDL-C administering high- or moderate-intensity statin therapy depending on the CVD risk. The problems of adopting these new guidelines are herein discussed.
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