Guideline on the treatment of blood cholesterol: Difference between revisions
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==[[ACC AHA guideline on the treatment of blood cholesterol|ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCV Risk in Adults]]== | == 2018 AHA/ACC Guideline on the Management of Blood Cholesterol. == | ||
==[[ACC AHA guideline on the treatment of blood cholesterol safety|Safety]]== | === Statin and adverse effects === | ||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''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 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''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''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''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''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |<nowiki>"</nowiki>'''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 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |"'''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 ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B-R]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |"'''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. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-LD]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen" |"'''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)<nowiki>''</nowiki> | |||
|} | |||
<ref name="pmid30423391">{{cite journal| author=Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS | display-authors=etal| title=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. | journal=J Am Coll Cardiol | year= 2019 | volume= 73 | issue= 24 | pages= 3168-3209 | pmid=30423391 | doi=10.1016/j.jacc.2018.11.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30423391 }}</ref> | |||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
| bgcolor="LemonChiffon" |"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(''[[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:]] B-R)'' <nowiki>"</nowiki> | |||
|} | |||
<ref name="pmid30423391" /> | |||
{| class="wikitable" style="width:80%" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightCoral" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | |||
|- | |||
| bgcolor="LightCoral" |"9'''.''' Coenzyme Q10 is not recommended for routine use in patients treated with statins or for the treatment of SAMS. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:B-R]])'' <nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightCoral" |"10'''.''' . In patients treated with statins, routine measurements of creatine kinase and transaminase levels are not useful (Level of Evidence C-LD)<nowiki>''</nowiki> | |||
|} | |||
<ref name="pmid30423391" /> | |||
==[[ACC AHA guideline on the treatment of blood cholesterol|2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce ASCV Risk in Adults]]== | |||
[[File:ACCAHA cholesterol treatment algorithm.jpg|900px]] | |||
===[[ACC AHA guideline on the treatment of blood cholesterol statin treatment|Statin Treatment]]=== | |||
'''[[ACC AHA guideline on the treatment of blood cholesterol intensity of statin therapy in primary and secondary prevention|Intensity of Statin Therapy]] | [[ACC AHA guideline on the treatment of blood cholesterol LDL and non-HDL treatment goals|LDL and Non-HDL Treatment Goals]] | [[ACC AHA guideline on the treatment of blood cholesterol primary prevention|Primary Prevention]] | [[ACC AHA guideline on the treatment of blood cholesterol secondary prevention|Secondary Prevention]] | [[ACC AHA guideline on the treatment of blood cholesterol heart failure and hemodialysis|Heart Failure and Hemodialysis]]''' | |||
===[[ACC AHA guideline on the treatment of blood cholesterol safety|Safety]]=== | |||
'''[[ACC AHA guideline on the treatment of blood cholesterol safety#Statin Safety Recommendations|Statin]] | [[ACC AHA guideline on the treatment of blood cholesterol safety#Nonstatin Safety Recommendations|Nonstatin]]''' | '''[[ACC AHA guideline on the treatment of blood cholesterol safety#Statin Safety Recommendations|Statin]] | [[ACC AHA guideline on the treatment of blood cholesterol safety#Nonstatin Safety Recommendations|Nonstatin]]''' | ||
==[[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy|Managing Statin Therapy]]== | ===[[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy|Managing Statin Therapy]]=== | ||
'''[[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Monitoring Statin Therapy|Monitoring Statin Therapy]] | [[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Optimizing Statin Therapy|Optimizing statin therapy]] | [[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Insufficient Response to Statin Therapy|Insufficient Response]]''' | '''[[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Monitoring Statin Therapy|Monitoring Statin Therapy]] | [[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Optimizing Statin Therapy|Optimizing statin therapy]] | [[ACC AHA guideline on the treatment of blood cholesterol Managing Statin Therapy#Insufficient Response to Statin Therapy|Insufficient Response]]''' | ||
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[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
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Latest revision as of 15:51, 2 December 2022
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
Statin Treatment
Intensity of Statin Therapy | LDL and Non-HDL Treatment Goals | Primary Prevention | Secondary Prevention | Heart Failure and Hemodialysis
Safety
Managing Statin Therapy
Monitoring Statin Therapy | Optimizing statin therapy | Insufficient Response
Template:WikiDoc Sources
CME Category::Cardiology
- ↑ 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.