The ACC/AHA 2013 lipid guideline informs most elements of hyperlipidemia management and is the basis for most content in this module. This 2013 guideline marked a shift from previous guidelines from the National Heart, Blood, and Lung Institute (NHLBI) because it is more rooted in randomized controlled trial (RCT) evidence. The “new” recommendations do not include specific levels of LDL to target treatment, which is in contrast to the traditional approach in management. Statin therapy, the cornerstone of lipid treatment, is recommended to be used in fixed doses–rather than titration of dosing to achieve a certain LDL level, which was the practice for decades prior to the guideline. The 2013 guideline recognizes that lifestyle modifications (diet, exercise, weight and tobacco avoidance) are the cornerstone of ASCVD prevention in addition to drug therapy. Although more firmly rooted in RCT evidence, the 2013 guideline does include a substantial number of recommendations based on expert opinion of ACC/AHA committee members. This module highlights those 2013 ACC/AHA recommendations which are based on RCT data (rather than expert opinion). It is important to recognize that the 2013 guideline for drug therapy does not apply to 3 important groups of people, due to less evidence:
- age >75 years (unless clinical CVD)
- need for hemodialysis
- NYHA Class II, III, IV heart failure
2013 ACC/AHA Lipid Guideline Resources for Physicians and Students
- 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults
- Lifestyle Interventions to Reduce Cardiovascular Risk: Systematic Review from the Lifestyle Work Group
- 10-year ACC/AHA Risk Calculator
- A Pragmatic View of the New Cholesterol Treatment Guideline (New England Journal of Medicine, November 2013)
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