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AACE: CVD ‘extreme risk’ category introduced in updated lipid guidelines
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The American Association of Clinical Endocrinologists and the American College of Endocrinology have introduced substantial updates to a clinical practice guideline for dyslipidemia management, including a new “extreme risk” category for cardiovascular disease and new lipid management strategies, the organizations announced in a press release.
The updated guideline, originally published in 2012, now notes that adults with established CVD accompanied by type 2 diabetes, chronic kidney disease (stages 3 or 4) or familial hypercholesterolemia should be considered at extreme risk for atherosclerotic CVD, as should those with progressive CVD, including adults with unstable angina who have achieved a lowered LDL cholesterol level.
“This update expands considerably on our previous knowledge base and with newer clinical trial data, [and] addresses a broader range of disease stages with more intense treatment and more aggressive intervention,” Paul S. Jellinger, MD, MACE, chair of the guideline task force, said in a statement.
Jellinger and colleagues noted that treatment goals should be personalized according to the level of patient risk. For patients considered to be at extreme risk, an LDL cholesterol goal of less than 55 mg/dL is recommended, they wrote.
Statins remain the primary recommended agent to achieve target LDL cholesterol goals, based on morbidity and mortality outcome trials, but the guideline notes that PCSK9 inhibitors should be considered for use in combination with statins for individuals with familial hypercholesterolemia or those with clinical CVD who could not reach LDL cholesterol goals with maximally tolerated statin therapy.
The guideline also supports the use of apolipoprotein B level and/or LDL particle concentration to help achieve LDL cholesterol-lowering goals, provides screening recommendations for individuals of different ages and identifies special issues for children and adolescents, who researchers noted should be diagnosed and managed as early as possible.
The researchers also emphasized the importance of screening women for CVD to determine the 10-year risk (high, intermediate or low) for a coronary event, using the Reynolds Risk Score or the Framingham Risk Assessment Tool.
“This statement will not only improve detection of the disease, but also provide the support necessary for physicians to ensure patients receive appropriate workup and optimal disease management to reduce further [CV] morbidity and mortality in these extreme-risk patient groups,” Yehuda Handelsman, MD, FACP, FNLA, FACE, a co-chair of the guideline task force, said in a statement.
An executive summary of the guideline will be published as an online supplement to the April issue of Endocrine Practice. To view the complete guideline, visit https://www.aace.com/files/lipid-guidelines.pdf. – by Regina Schaffer
Disclosure: Please see the complete guideline for the authors’ relevant financial disclosures.
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