Clinical Practice Guideline

Cholesterol

Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

(Endorsed with Qualifications, June 2014)

The guideline, Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, was developed by the American College of Cardiology (ACC)/American Heart Association (AHA), and endorsed with qualifications by the American Academy of Family Physicians.

Key Recommendations

  • Individuals with LDL-C ≥ 190 mg/dL or triglycerides ≥ 500 mg/dL should be evaluated for secondary causes of hyperlipidemia.
  • Adults ≥ 21 years of age with a primary LDL-C ≥ 190 mg/dL should be treated with high-intensity statin therapy unless contraindicated.
  • Adults 40-75 years of age with an LDL-C 70-189 mg/dL without clinical ASCVD or diabetes and an estimated ten-year ASCVD risk ≥ 7.5% should be treated with moderate- to high-intensity statin therapy.
  • Adults 40-75 years of age with diabetes mellitus and an LDL-C 70-189 mg/dL should be treated with moderate-intensity statin therapy.
  • Individuals ≤ 75 years of age who have clinical ASCVD should be treated with high-intensity statin therapy unless contraindicated.
  • There is not enough evidence to recommend for or against treating blood cholesterol to target levels.
  • There is not enough evidence to recommend the use of non-statin medication combined with statin therapy to further reduce ASCVD events.

Qualifications

  • The guideline uses a CVD risk assessment tool that has not been validated and may overestimate risk. The risk cut-off of 7.5%, rather than 10%, will significantly increase the number of individuals on statins.
  • Many of the recommendations were based on expert opinion, although the key points are evidence based.
  • Seven of the 15 members of the guideline panel had conflicts of interest.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.