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Moving Toward the Next Paradigm for Cardiovascular Prevention
Editorial   Open access

Moving Toward the Next Paradigm for Cardiovascular Prevention

Jennifer G Robinson and Kausik Ray
Circulation (New York, N.Y.), Vol.133(16), pp.1533-1536
2016
DOI: 10.1161/CIRCULATIONAHA.116.022134
PMID: 27142603
url
https://doi.org/10.1161/CIRCULATIONAHA.116.022134View
Published (Version of record) Open Access

Abstract

Guidelines change based on new evidence and methods. The Adult Treatment Panel guidelines evolved over their 3 iterations and focused on a treat-to-goal approach. Following a rigorous systematic review of randomized trials of cholesterol-lowering drug therapy with cardiovascular outcomes, the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guideline moved away from the approach recommended in earlier Adult Treatment Panel guidelines, to a new paradigm (Figure 1) for cholesterol treatment based on the use of statin therapy in 4 statin benefit groups, in which there was a clear net atherosclerotic cardiovascular disease (ASCVD) reduction benefit.1 For primary prevention, strong evidence from 3 exclusively primary prevention trials supported the initiation of statin therapy in those with ≥7.5% 10-year ASCVD risk, and moderate evidence supported statin therapy for those with 5 to <7.5% 10-year ASCVD risk. However, the guidelines stated that the decision to start statin therapy in these patients and in lower-risk patients should be deliberated within the context of shared decision making in a Clinician-Patient Discussion, because of the potentially narrower margin of benefit and need to elicit patient preferences. Consideration could also be given to other characteristics that may increase ASCVD risk, including family history of premature ASCVD, elevated coronary artery calcium score, high-sensitivity C-reactive protein ≥2 mg/L, ankle brachial index <0.9, or increased lifetime ASCVD risk, or a low-density lipoprotein (LDL-C) level of ≥160 mg/dL.Figure 1. Treatment paradigms for cholesterol treatment guidelines evolve after incorporating accumulated new evidence and methods. ACC/AHA indicates American College of Cardiology/American Heart Association; ATP, Adult Treatment Panel; and CVD, cardiovascular disease.Article, see p 1574Since the completion of the 2013 ACC/AHA cholesterol guidelines, several important analyses have been published that should inform future primary prevention guideline updates. Based on a Cholesterol Treatment Trialists2 meta-analysis that found that each 39 mg/dL …

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