Statin therapy for ASCVD prevention: Difference between revisions

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==Major Recommendations for Statin Therapy for ASCVD Prevention==
==Major Recommendations for Statin Therapy for ASCVD Prevention==
The following is a treatment algorithm proposed by the AHA/ACC guidelines committee:<ref name="pmid24222016">{{cite journal| author=Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al.| title=2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= 129 | issue= 25 Suppl 2 | pages= S1-S45 | pmid=24222016 | doi=10.1161/01.cir.0000437738.63853.7a | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24222016  }} </ref>
 
===2016 USPSTF Recommendations===
 
[[Clinical practice guidelines]] <ref name="pmid27838723">{{cite journal| author=US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW et al.| title=Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement. | journal=JAMA | year= 2016 | volume= 316 | issue= 19 | pages= 1997-2007 | pmid=27838723 | doi=10.1001/jama.2016.15450 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27838723  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=28320000 Review in: Ann Intern Med. 2017 Mar 21;166(6):JC26] </ref> and [[systematic review]] <ref name="pmid27905702">{{cite journal| author=Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Grusing S et al.| title=Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force | journal=U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews | year= 2016 | volume=139  | issue=  | pages=  | pmid=27905702 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/books/NBK396415/ }} </ref> by the [[United States Preventive Services Task Force]] in 2016 stated: 
 
* '''Grade B''': The USPSTF recommends low-moderate intensity statin for adults without a history of cardiovascular disease (CVD) for the prevention of CVD events and mortality when all criteria are met:
** Age 40 to 75 years
** 1 or more cardiovascular disease risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking)
** Calculated 10-year cardiovascular risk of 10% or greater.
* '''Grade C''': The USPSTF gives clinicians the option to offer a low- to moderate-dose statin to certain adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 7.5% to 10%.
* '''Grade I''': The USPSTF does not recommend statin therapy for primary prevention of CVD events and mortality in adults 76 years old due to insufficient evidence to assess benefits vs. risks.
 
The projected benefits of statin therapy include decreased incidences of the following<ref name="pmid27905702">{{cite journal| author=Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Grusing S et al.| title=Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force | journal=U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews | year= 2016 | volume=139  | issue=  | pages=  | pmid=27905702 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/books/NBK396415/ }} </ref>:
* All-cause mortality (NNT 250)
* Cardiovascular mortality (NNT 233)
* Composite cardiovascular outcomes (NNT 72)
 
===2013 AHA/ACC Guidelines===
 
The following is a treatment algorithm proposed by the AHA/ACC guidelines committee:<ref name=ACC/AHA-Chol-Guide> 2013 ACC/AHA Guideline on the
Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. http://ac.els-cdn.com/S0735109713060282/1-s2.0-S0735109713060282-main.pdf?_tid=06f509a0-9c67-11e6-b670-00000aab0f01&acdnat=1477587879_04fcb2e98e9d9b3a556253eefd0247d2 Accessed on October 27, 2016</ref><ref name="pmid24222016">{{cite journal| author=Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH et al.| title=2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. | journal=Circulation | year= 2014 | volume= 129 | issue= 25 Suppl 2 | pages= S1-S45 | pmid=24222016 | doi=10.1161/01.cir.0000437738.63853.7a | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24222016  }} </ref>
[[File:ACCAHA cholesterol treatment algorithm.jpg|900px]]
[[File:ACCAHA cholesterol treatment algorithm.jpg|900px]]


Line 10: Line 31:
Initial evaluation prior to statin initiation include:
Initial evaluation prior to statin initiation include:
*Fasting lipid panel  
*Fasting lipid panel  
**Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level !220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are !500 mg/dL, a fasting lipid panel is required.
**Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level ≥220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required.
*ALT
*ALT
*CK
*CK
*Consider evaluation for other secondary causes
*Consider evaluation for other secondary causes


==References==
{| class="wikitable"
!Secondary Cause
!Elevated LDL-C
!Elevated Triglycerides
|-
|Diet
|Saturated or trans fats
 
Weight gain
 
Anorexia nervosa
|Weight gain
Very-low-fat diets
 
High intake of refined carbohydrates
 
Excessive alcohol intake
|-
|Drugs
|Diuretics
 
Cyclosporine
 
Glucocorticoids
 
Amiodarone
|Oral estrogens
 
Glucocorticoids
 
Bile acid sequestrants
 
Protease inhibitors
 
Retinoic acid
 
Anabolic steroids
 
Sirolimus
 
Raloxifene
 
Tamoxifen
 
Beta blockers
|-
|Diseases
|Biliary obstruction
Nephrotic syndrome
|Nephrotic syndrome
Chronic renal failure
 
Lipodystrophies
|-
|Disorders and altered states of metabolism
|Hypothyroidism
Obesity
 
Pregnancy
|Diabetes (poorly controlled)
 
Hypothyroidism
 
Obesity
 
Pregnancy
|}
[[Image:ACCAHA cholesterol treatment ASCVD.jpg|800px]]
 
{{Reflist|2}}
{{Reflist|2}}


Latest revision as of 20:14, 6 February 2019

Template:Hypercholesterolemia Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Major Recommendations for Statin Therapy for ASCVD Prevention

2016 USPSTF Recommendations

Clinical practice guidelines [1] and systematic review [2] by the United States Preventive Services Task Force in 2016 stated:

  • Grade B: The USPSTF recommends low-moderate intensity statin for adults without a history of cardiovascular disease (CVD) for the prevention of CVD events and mortality when all criteria are met:
    • Age 40 to 75 years
    • 1 or more cardiovascular disease risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking)
    • Calculated 10-year cardiovascular risk of 10% or greater.
  • Grade C: The USPSTF gives clinicians the option to offer a low- to moderate-dose statin to certain adults aged 40 to 75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 7.5% to 10%.
  • Grade I: The USPSTF does not recommend statin therapy for primary prevention of CVD events and mortality in adults 76 years old due to insufficient evidence to assess benefits vs. risks.

The projected benefits of statin therapy include decreased incidences of the following[2]:

  • All-cause mortality (NNT 250)
  • Cardiovascular mortality (NNT 233)
  • Composite cardiovascular outcomes (NNT 72)


2013 AHA/ACC Guidelines

The following is a treatment algorithm proposed by the AHA/ACC guidelines committee:[3][4]

Initial evaluation prior to statin initiation

Initial evaluation prior to statin initiation include:

  • Fasting lipid panel
    • Fasting lipid panel preferred. In a nonfasting individual, a non–HDL-C level ≥220 mg/dL could indicate genetic hypercholesterolemia that requires further evaluation or a secondary etiology. If nonfasting triglycerides are ≥500 mg/dL, a fasting lipid panel is required.
  • ALT
  • CK
  • Consider evaluation for other secondary causes
Secondary Cause Elevated LDL-C Elevated Triglycerides
Diet Saturated or trans fats

Weight gain

Anorexia nervosa

Weight gain

Very-low-fat diets

High intake of refined carbohydrates

Excessive alcohol intake

Drugs Diuretics

Cyclosporine

Glucocorticoids

Amiodarone

Oral estrogens

Glucocorticoids

Bile acid sequestrants

Protease inhibitors

Retinoic acid

Anabolic steroids

Sirolimus

Raloxifene

Tamoxifen

Beta blockers

Diseases Biliary obstruction

Nephrotic syndrome

Nephrotic syndrome

Chronic renal failure

Lipodystrophies

Disorders and altered states of metabolism Hypothyroidism

Obesity

Pregnancy

Diabetes (poorly controlled)

Hypothyroidism

Obesity

Pregnancy

  1. ↑ US Preventive Services Task Force. Bibbins-Domingo K, Grossman DC, Curry SJ, Davidson KW, Epling JW; et al. (2016). "Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement". JAMA. 316 (19): 1997–2007. doi:10.1001/jama.2016.15450. PMID 27838723. Review in: Ann Intern Med. 2017 Mar 21;166(6):JC26
  2. ↑ 2.0 2.1 Chou R, Dana T, Blazina I, Daeges M, Bougatsos C, Grusing S; et al. (2016). "Statin Use for the Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force". U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. 139. PMID 27905702.
  3. ↑ 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. http://ac.els-cdn.com/S0735109713060282/1-s2.0-S0735109713060282-main.pdf?_tid=06f509a0-9c67-11e6-b670-00000aab0f01&acdnat=1477587879_04fcb2e98e9d9b3a556253eefd0247d2 Accessed on October 27, 2016
  4. ↑ Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH; et al. (2014). "2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. 129 (25 Suppl 2): S1–S45. doi:10.1161/01.cir.0000437738.63853.7a. PMID 24222016.


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