Guideline on the treatment of blood cholesterol

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

2018 AHA/ACC Guideline on the Management of Blood Cholesterol.

Statin and adverse effects

Class I
"1. A clinician-patient risk discussion is recommended before initiation of statin therapy to review net clinical benefit, weighing the potential for ASCVD risk reduction against the potential for statin-associated side effects, statin–drug interactions, and safety, while emphasizing that side effects can be addressed successfully (Level of Evidence: A) "
"2. In patients with statin-associated muscle symptoms (SAMS), a thorough assessment of symptoms is recommended, in addition to an evaluation for nonstatin causes and predisposing factors(Level of Evidence: A) "
"3. In patients with indication for statin therapy, identification of potential predisposing factors for statin-associated side effects, including new-onset diabetes mellitus and SAMS, is recommended before initiation of treatment(Level of Evidence: B-R) "
"4. In patients with a recent or remote history of MI or acute coronary syndrome (ACS) and LVEF ≤40%, evidence-based beta blockers should be used to reduce mortality (Level of Evidence: B-R) "
"5. In patients with increased diabetes mellitus risk or new-onset diabetes mellitus, it is recommended to continue statin therapy, with added emphasis on adherence, net clinical benefit, and the core principles of regular moderate-intensity physical activity, maintaining a healthy dietary pattern, and sustaining modest weight loss (Level of Evidence: B-R) "
"6. In patients treated with statins, it is recommended to measure creatine kinase levels in individuals with severe statin-associated muscle symptoms, and objective muscle weakness, and to measure liver transaminases (aspartate aminotransferase, alanine aminotransferase) as well as total bilirubin and alkaline phosphatase (hepatic panel) if there are symptoms suggesting hepatotoxicity. (Level of Evidence: C-LD) "
"7. In patients at increased ASCVD risk with chronic, stable liver disease (including non-alcoholic fatty liver disease) when appropriately indicated, it is reasonable to use statins after obtaining baseline measurements and determining a schedule of monitoring and safety checks (Level of Evidence B-R)''


Class IIa
"8. In patients at increased ASCVD risk with severe statin-associated muscle symptoms or recurrent statin-associated muscle symptoms despite appropriate statin rechallenge, it is reasonable to use RCT-proven nonstatin therapy that is likely to provide net clinical benefit(Level of Evidence: B-R) "


Class III (No Benefit)
"9. Coenzyme Q10 is not recommended for routine use in patients treated with statins or for the treatment of SAMS. (Level of Evidence:B-R) "
"10. . In patients treated with statins, routine measurements of creatine kinase and transaminase levels are not useful (Level of Evidence C-LD)''


2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCV Risk in Adults

ACCAHA cholesterol treatment algorithm.jpg

Statin Treatment

Intensity of Statin Therapy | LDL and Non-HDL Treatment Goals | Primary Prevention | Secondary Prevention | Heart Failure and Hemodialysis


Statin | Nonstatin

Managing Statin Therapy

Monitoring Statin Therapy | Optimizing statin therapy | Insufficient Response

Template:WikiDoc Sources CME Category::Cardiology

  1. 1.0 1.1 1.2 Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS; et al. (2019). "2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines". J Am Coll Cardiol. 73 (24): 3168–3209. doi:10.1016/j.jacc.2018.11.002. PMID 30423391.