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New guidelines released by AHA, ACC highlight expanded use of statins
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On November 12, 2013, the American Heart Association and American College of Cardiology published clinical practice guidelines for assessment of cardiovascular risk, lifestyle modification to reduce cardiovascular risk, management of blood cholesterol and management of overweight and obesity in adults. These guidelines, which were developed to promote optimal patient care and cardiovascular health, have been endorsed by WomenHeart: The National Coalition for Women with Heart Disease. The recommendations will be of value to primary care clinicians as well as specialists concerned with atherosclerotic cardiovascular disease (ASCVD) prevention.

"An important part of the new guidelines is more refined risk assessment, especially in women and African Americans,” says Karol Watson, MD, Co-director of the UCLA Center for Cholesterol and Lipid Management and Chair of WomenHeart’s Scientific Advisory Council. "The addition of stroke to the risk estimation paradigm is especially important for women.”

The Cholesterol Guidelines are intended to provide a strong evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in both women and men. The Expert Panel was charged with updating the clinical practice recommendations for the treatment of blood cholesterol levels to reduce ASCVD, which includes coronary heart disease (CHD), stroke, and peripheral arterial disease.

These guidelines identify lifestyle as the foundation for ASCVD risk reduction efforts and emphasized that lifestyle modification (i.e., adhering to a heart healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight) remains a critical component of health promotion and ASCVD risk reduction, both prior to and in concert with the use of cholesterol lowering drug therapies.

By using data to identify those most likely to benefit from cholesterol-lowering statin therapy, the Expert Panel found extensive and consistent evidence supporting the use of statins for the prevention of ASCVD in many higher risk primary and all secondary prevention individuals without heart failure and who were not receiving hemodialysis. Therefore, moderate or intensive statin therapy is recommended for individuals at increased ASCVD risk who are most likely to experience a net benefit for ASCVD risk reduction.

Four major statin benefit groups were identified for whom the ASCVD risk reduction clearly outweighs the risk of adverse events:

  • Individuals with clinical ASCVD
  • Individuals with primary elevations of LDL cholesterol greater than 190 mg/dL,
  • Diabetics aged 40 to 75 years with LDL cholesterol from 70 to189 mg/dL and without clinical ASCVD
  • Individuals 40-75 years of age with LDL cholesterol 70 to189 mg/dL and an estimated 10-year ASCVD risk of 7.5% or higher.

The Panel states that because evidence shows that the absolute benefit of statin treatment is proportional to baseline ASCVD risk, treatment decisions for women, racial and ethnic subgroups should be based on the level of estimated 10 year risk of ASCVD. This recommendation is a departure from previous approaches that focused on LDL cholesterol levels to guide treatment decisions, which lead to overtreatment in lower risk groups such as younger, non-Hispanic white women and undertreatment in higher risk groups such as African American women and men.

C. Noel Bailey Merz, MD, Director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai Medical Center and an emeritus member of the WomenHeart Scientific Advisory Council, notes that an important component of the guidelines is "the simplified approach to secondary prevention:use of a moderate to high fixed-dose of a potent statin.”

The Panel concludes that implementation of these ASCVD risk reduction guidelines will help to substantially address the large burden of fatal and nonfatal ASCVD in the United States. To view all of the ACC/AHA Guidelines endorsed by WomenHeart, click here. 

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WomenHeart: The National Coalition for Women with Heart Disease is a nonprofit, 501(c)(3) patient advocacy organization with thousands of members nationwide, including women heart patients and their families, health care providers, advocates and consumers committed to helping women live longer, healthier lives. WomenHeart supports, educates and advocates on behalf of the nearly 48 million American women living with or at risk of heart disease. Our programs are made possible by donations, grants and corporate partnerships.

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