What approach is now AHA/ACC guideline-recommended for a patient with primary hypercholesterolemia, with an LDL-C of 192 mg/dL? Take Quiz #3.
1. Which of the options above would be guideline-recommended care for a patient with primary hypercholesterolemia, with an LDL-C of 192 mg/dL?
Answer: C. Start high-intensity statin. For high-risk patients with severe primary hypercholesterolemia (LDL-C >190 mg/dL), the AHA/ACC guidelines recommend initiating a high-intensity statin without calculating the 10-year ASCVD risk or obtaining a CAC score. Ezetimibe should then be considered for treatment intensification followed by a PCSK9 inhibitor.
Answer: B. 42-year-old woman with diabetes and LDL-C of 72 mg/dL. All patients with diabetes aged 40-75 with LDL ≥70 mg/dL have a class IA recommendation in the guidelines to initiate at least moderate intensity statin therapy. The man in option A warrants intensification of lifestyle therapy as the next step. The 80-year-old in option C falls outside the age range for the guideline statin benefit groups and of ASCVD.
Statin therapy benefit group? The 50-year-old woman with psoriasis (option D) and the 42-year-old woman in early menopause (option E) may benefit from a statin – but not until after a discussion of treatment options and consideration of CAC for refinement of risk assessment.
3. Which of the options above would be recommended as the first step for a 22-year-old overweight man presenting with LDL-C of 153 mg/dL?
Answer: D. Intensify lifestyle therapy (moderate caloric restriction, regular exercise). In young adults aged 20 to 39 years, a healthy lifestyle is the foundation of ASCVD risk reduction. The other options are not indicated as the first step for this 22-year-old.
For parts I and II of the AHA/ACC lipid guidelines quiz:
(See next slide for information sources)
Arps K, Blumenthal RS, Martin SS. New aspects of the risk assessment guidelines: Practical highlights, scientific evidence and future goals [Expert analysis]. American College of Cardiololgy Web site. Published Nov 15, 2018.
Grundy SM, Stone NJ, Bailey AL, 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. Circulation. 2018;DOI: 10.1161/CIR.0000000000000625.
Pallazola V, Cardoso R, Blumenthal RS, Martin SS. Was the juice worth the squeeze? Understanding the new 2018 AHA/ACC cholesterol guideline [Expert analysis]. American College of Cardiology Web site. Published Nov 15, 2018