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The 2018 Cholesterol Management Guidelines: Topics in Secondary ASCVD Prevention Clinicians Need to Know

  • Coronary Heart Disease (S. Virani and S. Naderi, Section Editors)
  • Published:
Current Atherosclerosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The 2018 ACC/AHA Multisociety blood cholesterol guidelines provide updated recommendations based on contemporary evidence on the management of serum cholesterol for the prevention of atherosclerotic cardiovascular disease (ASCVD) events. This review discusses clinically important topics in the new guidelines related to secondary ASCVD prevention.

Recent Findings

Since the 2013 ACC/AHA blood cholesterol guidelines, several large randomized control trials involving ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab) have been published. The trials provided evidence that these non-statin, LDL-cholesterol lowering agents are efficacious in reducing risk for ASCVD events in patients with clinical ASCVD. The 2018 guidelines incorporate these new findings into updated clinical recommendations on therapeutic strategies related to the use of ezetimibe and PCSK9 inhibitors. The guidelines also recommend risk stratification of secondary prevention patients to identify those at very high-risk of ASCVD events as these patients would derive the most absolute risk reduction from the addition of non-statin therapies.

Summary

While high-intensity statins remain the first-line treatment to prevent recurrent ASCVD events in secondary prevention patients, ezetimibe and PCSK9 inhibitors are evidence-based non-statin agents that can be used when residual on top of maximally tolerated statin therapy in patients deemed to be at very-high risk of recurrent ASCVD events.

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Author notes

  1. Xiaoming Jia and Mahmoud Al Rifai denote equal contribution.

Authors and Affiliations

  1. Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Xiaoming Jia & Salim S. Virani

  2. Department of Medicine, University of Kansas School of Medicine, Wichita, KS, USA

    Mahmoud Al Rifai

  3. Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA

    Mahmoud Al Rifai

  4. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Yochai Birnbaum

  5. Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Sidney C. Smith Jr

  6. Health Policy, Quality and Informatics Program, Health Services Research and Development Center for Innovations, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA

    Salim S. Virani

  7. Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA

    Salim S. Virani

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  1. Xiaoming Jia
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Correspondence to Salim S. Virani.

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Xiaoming Jia, Mahmoud Al Rifai, Yochai Birnbaum, Sidney C. Smith Jr., and Salim S. Virani declare no conflict of interest.

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Jia, X., Al Rifai, M., Birnbaum, Y. et al. The 2018 Cholesterol Management Guidelines: Topics in Secondary ASCVD Prevention Clinicians Need to Know. Curr Atheroscler Rep 21, 20 (2019). https://doi.org/10.1007/s11883-019-0784-8

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  • DOI: https://doi.org/10.1007/s11883-019-0784-8

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