New ACC/AHA Cholesterol Guideline Allows For More Personalized Care; New Treatment Options
The new 2018 ACC/AHA Guideline on the Management of Blood Cholesterol was released this morning during AHA 2018 in Chicago and simultaneously published in the Journal of the American College of Cardiology and Circulation. The new guideline updates its 2013 predecessor and provides recommendations to greater personalized care. Among the biggest changes: more detailed risk assessments and new cholesterol-lowering drug options for people at the highest risk for cardiovascular disease.
“High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care,” said ACC President C. Michael Valentine, MD, FACC. “Over the past five years, we’ve learned even more about new treatment options and which patients may benefit from them. By providing a treatment roadmap for clinicians, we are giving them the tools to help their patients understand and manage their risk and live longer, healthier lives.”
In addition to traditional risk factors such as smoking, high blood pressure and high blood sugar, the new guideline adds factors like family history and ethnicity, as well as certain health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia and high lipid biomarkers, to help health care providers better determine individualized risk and treatment options. It also recommends coronary artery calcium scores as a second-line decision-making tool with patients when determining whether to use statins, as well as elective cholesterol screening for children as young as two who have a family history of heart disease or high cholesterol. In most children, an initial screening test can be considered between the ages of nine and 11 and then again between 17 and 21.
The guideline also sets out very specific recommendations for clinicians to discuss options with patients in the newly defined “very high risk of ASCVD” category who still have LDL-C above 70 mg/dL after maximizing statin therapy. It recommends considering other non-statin drugs, including ezetimibe and PCSK9 inhibitors. For the first time, the new guideline also includes a Value Statement that underscores the need for clinicians and patients to factor in the cost of drugs in determining the most appropriate treatment rates. The guideline gives PCSK9 inhibitors a low-cost value for patients at very high risk of ASCVD and uncertain value for patients with familial hypercholesterolemia compared to good cost value based on pricing through mid-2018. However, it remains to be seen if recent reductions in pricing for some PCSK9 inhibitors and results from clinical outcomes results from studies like ODYSSEY OUTCOMES could alter the value equation down the road.
“The ACC has long recognized that the cost of PCSK9s have made patient access an issue. We are committed to helping physicians with access to care issues, while also bringing together stakeholders, including payer, industry and clinician representatives, to talk about opportunities to move forward together,” Valentine said. “Our goal is to make sure the highest risk patients have access to the care they need.”
The ACC has developed both clinician and patient tools to help understand the new guideline and implement recommendations at the point of care. These tools, including mobile apps, infographics, key perspectives, a comparison chart and “Guideline Made Simple” tool, are available on the Cholesterol Guideline Hub on ACC.org. A separate cholesterol guideline hub with links to all JACC-related resources is also available at onlinejacc.org/guidelines/cholesterol.
The ACC will be sharing links to individual tools and resources, as well as encouraging discussion on social media over the next several days. ACC leaders are encouraged to follow @ACCinTouch on Twitter and share these messages with you respective followers. In addition, the ACC will be covering AHA 2018 late-breaking science throughout the course of the meeting. Follow along on social media using #AHA18, and visit ACC.org/AHA2018. Hot trials from today will include VITAL, REDUCE-IT, ODYSSEY OUTOMES Economic Study, and DECLARE-TIMI 58.
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