The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) announced the publication of updated clinical practice guidelines for dyslipidemia management and atherosclerosis prevention, introducing a new cardiovascular risk category and accompanying lipid management goals

The clinical practice guidelines serve as a guidance on screening, risk assessment, and treatment recommendations for various lipid disorders. The 2017 update includes a new cardiovascular disease “Extreme Risk” category and lipid-lowering treatment goals. The Extreme Risk category includes:

  • patients who have a progressive cardiovascular disease, including patients with unstable angina, after achieving an LDL cholesterol level <70mg/dL
  • patients who have established cardiovascular disease accompanied by diabetes mellitus, chronic kidney disease (stages 3 or 4), or familial hypercholesterolemia
  • men aged ≤55 years or women aged ≤65 years who have a history of premature cardiovascular disease

Treatment goals for patients in the Extreme Risk category include LDL cholesterol <55mg/dL, non-HDL cholesterol <80mg/dL, and ApoB <70mg/dL. 

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The guidelines highlight the importance of assessing women for cardiovascular disease using tools to determine the 10-year risk for a coronary event. The risk (high, intermediate, or low) should be assessed using the Reynolds Risk Score or the Framingham Risk Assessment Tool (Grade C).

Also, dyslipidemia in childhood and adolescence should be diagnosed and managed as early as possible to decrease the long-term risk of cardiovascular events in adulthood (Grade A). LDL cholesterol <100mg/dL is categorized as Acceptable; 100–129mg/dL is Borderline; and ≥130mg/dL is considered High.

The guidelines also include an assessment of the value of adding ezetimibe and PCSK9 inhibitors in patients with cardiovascular disease who are unable to reach LDL cholesterol goals with statin therapy. When ezetimibe is coadministered with statins, an additional 25% reduction in LDL is observed resulting in a total 34–61% reduction in LDL. Ezetimibe can be used in combination with statins to further reduce both LDL-C and ASCVD risk (Grade A). PCSK9 inhibitors should be considered in patients with clinical cardiovascular disease who are unable to reach LDL-C/non-HDL-C goals with maximally tolerated statin therapy (Grade A). 

Dr. Paul S. Jellinger, MACE, Chair of the AACE Lipids Guidelines Update Task Force Writing Committee, stated, “This update expands considerably on our previous knowledge base and with newer clinical trial data addresses a broader range of disease stages with more intense treatment and more aggressive intervention.”

Complete guidelines are available online and the Executive Summary will be published as an online supplement to the April issue of Endocrine Practice

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