2018 Cholesterol Guidelines: Key Topics in Primary Prevention
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Purpose of Review
The 2018 American College of Cardiology (ACC) and American Heart Association (AHA) cholesterol guidelines are a comprehensive update providing recommendations for management of patients with high blood cholesterol based on the best available evidence. This review highlights key topics clinicians need to know for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on the 2018 ACC/AHA cholesterol guidelines.
The guidelines include a broad framework for risk estimation and management for primary prevention of ASCVD. Additional tools to refine risk assessment and guide management in primary prevention are outlined, including the use of risk-enhancing factors and coronary artery calcium score measurement.
Lifestyle modification, appropriate risk assessment, and the use of proven pharmacologic therapies are essential for effective primary prevention as outlined in the 2018 ACC/AHA cholesterol guidelines.
KeywordsPrimary prevention Cardiovascular disease Guidelines
Compliance with Ethical Standards
Conflict of Interest
Donald Clark III and Salim S. Virani declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
- 1.Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018.Google Scholar
- 3.Lloyd-Jones DM, Braun LT, Ndumele CE, et al. Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2018.Google Scholar
- 7.Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315–81.CrossRefGoogle Scholar
- 9.DeFilippis AP, Young R, McEvoy JW, et al. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort. Eur Heart J. 2017;38(8):598–608.PubMedGoogle Scholar
- 10.Colantonio LD, Richman JS, Carson AP, Lloyd-Jones DM, Howard G, Deng L, et al. Performance of the atherosclerotic cardiovascular disease pooled cohort risk equations by social deprivation status. J Am Heart Assoc. 2017;6(3).Google Scholar
- 11.Feinstein MJ, Nance RM, Drozd DR, Ning H, Delaney JA, Heckbert SR, et al. Assessing and refining myocardial infarction risk estimation among patients with human immunodeficiency virus: a study by the Centers for AIDS Research Network of Integrated Clinical Systems. JAMA Cardiol. 2017;2(2):155–62.CrossRefGoogle Scholar
- 13.Nasir K, Bittencourt MS, Blaha MJ, Blankstein R, Agatson AS, Rivera JJ, et al. Implications of coronary artery calcium testing among statin candidates according to American College of Cardiology/American Heart Association cholesterol management guidelines: MESA (multi-ethnic study of atherosclerosis). J Am Coll Cardiol. 2015;66(15):1657–68.CrossRefGoogle Scholar
- 16.Metkus TS, Brown T, Budoff M, Kingsley L, Palella FJ Jr, Witt MD, et al. HIV infection is associated with an increased prevalence of coronary noncalcified plaque among participants with a coronary artery calcium score of zero: Multicenter AIDS Cohort Study (MACS). HIV Med. 2015;16(10):635–9.CrossRefGoogle Scholar
- 17.Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38.CrossRefGoogle Scholar
- 22.Taylor F, Huffman MD, Macedo AF, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;(1):CD004816.Google Scholar
- 23.Doran B, Guo Y, Xu J, Weintraub H, Mora S, Maron DJ, et al. Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: insight from the National Health and Nutrition Examination Survey III (NHANES-III). Circulation. 2014;130(7):546–53.CrossRefGoogle Scholar
- 26.Egan BM, Li J, White K, Fleming DO, Connell K, Hernandez GT, et al. 2013 ACC/AHA cholesterol guideline and implications for healthy people 2020 cardiovascular disease prevention goals. J Am Heart Assoc. 2016;5(8).Google Scholar