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2019 guideline on the management of blood cholesterol

A CAC score of 1 to 99 suggests statin therapy, particularly for patients 55 years and older. Author disclosure: No relevant financial affiliations. / Vol. Editor’s Note: Similar to the 2013 ACC/AHA cholesterol guideline, this guideline has some utility for family physicians but is limited by several recommendations that will be challenging to implement and lack patient-oriented evidence. The decision to treat should include a discussion of the benefits and risks between the patient and clinician. Am Fam Physician. This guideline is a full update of the 2013 ACC/AHA cholesterol guideline. A 30% or greater reduction in LDL-C levels is recommended, and in high-risk patients a 50% or greater reduction is recommended. Immediate, unlimited access to all AFP content. Based on high-quality evidence from randomized controlled trials (RCTs), high-intensity statin therapy should be instituted with a goal of lowering LDL-C levels by 50% or more in patients with ASCVD up to 75 years of age. With FMX On Demand, you can access recorded FMX sessions led by family medicine experts, and earn up to 155 enduring CME credits. Based on moderate-quality evidence from RCTs, the addition of nonstatin drug therapy should be considered at a threshold LDL-C level of at least 70 mg per dL on maximal statin therapy in patients with ASCVD at very high risk. Cholesterol Management: ACC/AHA Updates Guideline • A nonfasting plasma lipid profile can be obtained to estimate ASCVD risk and document baseline LDL-C in adults 20... • Maximally tolerated statin therapy is recommended for patients 20 to … Adults ≥ 21 years of age with a primary LDL-C ≥ 190 mg/dL should be treated with high-intensity statin therapy unless contraindicated. Risk-enhancing factors include a family history of premature ASCVD; persistently elevated LDL-C levels of 160 mg per dL (4.14 mmol per L) or greater; metabolic syndrome; chronic kidney disease; history of preeclampsia or premature menopause (younger than 40 years); chronic inflammatory disorders (e.g., rheumatoid arthritis, psoriasis, chronic HIV infection); high-risk ethnic groups (e.g., south Asian descent); persistent triglyceride levels of 175 mg per dL (2.0 mmol per L) or greater; and, if measured in selected individuals, an apolipoprotein B level of 130 mg per dL (1.3 g per L) or greater, high-sensitivity C-reactive protein level of 2.0 mg per L (19.05 nmol per L) or greater, an ankle-brachial index less than 0.9, and lipoprotein (a) level of 50 mg per dL (1.79 μmol per L) or greater, especially at higher values of lipoprotein (a). All rights Reserved. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. 9(May 1, 2019) Based on moderate-quality evidence from nonrandomized trials, measuring fasting or nonfasting plasma lipid levels is effective in estimating ASCVD risk and documenting baseline LDL-C in adults 20 years and older who are not on lipid-lowering therapy. This guideline was reviewed by the AAFP and received an Affirmation of Value: https://doi.org/10.1016/j.jacc.2018.11.003, https://www.aafp.org/patient-care/clinical-recommendations/all/cholesterol.html, Risks of Elective Labor Induction vs. Expectant Management, Denosumab for Reducing Risk of Fractures in Postmenopausal Women. • Moderate-intensity statin therapy should be initiated without calculating a 10-year ASCVD risk for patients 40 to 75 years of age with diabetes mellitus. Find tools, tips, and up-to-date information to help you through virtual interviews and more. The AAFP uses the category of “Affirmation of Value” to support clinical practice guidelines that provide valuable guidance, but do not meet our criteria for full endorsement. 99/No. All rights Reserved. The guideline on Management of Blood Cholesterol was developed by the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and was categorized as Affirmation of Value by the American Academy of Family Physicians.

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