What's new and what's not in the AHA/ACC 2018 update to the 2013 lipid management guidelines? Try part I of our 3-part quiz and find out.
In late 2018, the American Heart Association and American College of Cardiology (AHA/ACC) published an update to the AHA/ACC 2013 guidelines on the treatment of blood cholesterol. While many of the fundamentals of the latter are preserved in the current version, there are important revisions including recommendations on the addition of non-statin therapies as adjunctive treatment for atherosclerotic cardiovascular disease (ASCVD), the use of LDL-C thresholds for considering when lipid lowering therapy should be intensified and optimizing use of coronary artery calcium (CAC) scoring.
1. True or False: The 2018 AHA/ACC Cholesterol Guidelines are similar to the 2013 guidelines in that they break down statin benefit into 4 major categories.
Answer: A. True. While the 2018 guidelines represent a major advance the 2013 version, they retain key elements established in that iteration, including the 4 major categories for statin benefit noted above. Statins remain first-line therapy for patients in any of these categories, in addition to lifestyle therapy.
2. Which of the statements aobve does NOT represent a significant change in the AHA/ACC 2018 cholesterol guidelines from the 2013 guidelines?
Answer: B. Emphasis on a heart healthy lifestyle as a foundation of treatment -- is not a change from the 2013 guidelines. Revisions and additions to the 2018 iteration include additional factors to improve prevention in intermediate-risk patients; an refined LDL-C estimation tool; guidance on use of PCSK9 inhibitors, ezetimibe; and a more robust endorsement of the role of CAC in guiding treatment.
3. In which of the patient scenarios above would the 2018 cholesterol guidelines recommend consideration of ezetimibe?
Answer: E. The 55-year-old man with history of MI and CKD on atorvastatin 40 mg/d, with LDL-C of 70 mg/dL would be a candidate for initiation of ezetimibe. In very high-risk ASCVD patients the 2018 guidelines recommend that clinicians discuss the addition of ezetimibe to maximally-tolerated statin therapy when LDL-C is ≥70 mg/dL.
The patient in option B is not at high risk and so would not be a candidate for a conversation about ezetimibe and the young obese patient in option D would ideally be prescribed a trial of healthy lifestyle intervention first before initiation of pharmacologic therapy.
Take this first in a series of 3 short quizzes to test your knowledge of what’s different in the 2018 vs 2013 AHA/ACC guidelines and what may be the same.