Cholesterol Treatment – Guidelines Pocket Cards for Doctors

Did you know that any old person (and by ‘any old’ I mean a regular, non-doctor person, not any OLD person!) can purchase the American Heart Association’s “guidelines pocket cards” meant to keep doctors up to date on latest treatment protocols/recommendations?

On the American Heart Association website, these pocket cards are described as:

“These quick reference tools provide instant access to current AHA/ASA and ACCF/AHA guidelines in a clear, concise format – available in print and in the Guideline Central Mobile app for iPhone, iPad and Android.”

AHAlogo_lifeiswhy-logoFor months, I have been wondering whether there have been any updates or changes to the November 2013 Cholesterol Guidelines – and how doctors are following – or not – the new guidelines. (More info about the 2013 guidelines here: The NEW guidelines for cholesterol-lowering statin meds).

To me, there’s been a startling dearth of information about how treatment of high cholesterol has changed – or not – since these guidelines were issued. So I was pleased to stumble upon these pocket guidelines for doctors – updated with the latest recommendations.  For just $8.99 I downloaded the cholesterol pocket guidelines and found them largely unchanged since the new guidelines were issued in November 2013.

Which is good, I guess.

That said, one new thing I learned from this pocket guide is that there are established goals for the more in-depth cholesterol tests like C-Reactive Protein and Coronary Artery Calcium – both tests I think I might benefit from.

While my $8.99 purchase would NOT let me print (grr), I was able to grab some text via the handy iPhone app. Love that.

So if you would like a peak at the ‘pocket guidelines’ your doctor may well use when considering how to treat your high cholesterol, read on. Fair warning: it’s, um, quite detailed and uses acronyms (it is, after all, for doctors) so I’ve included a simple glossary for some of the medical terms.

Here goes – what follows is the ‘key points’ section of the doctor ‘pocket guide’ for treating high cholesterol:

TITLE: Cholesterol Adult Management

KEY POINTS

  • Encourage adherence to a heart-healthy lifestyle. A healthy diet, regular aerobic physical activity, smoking cessation and maintenance of a healthy weight are critical components of ASCVD risk reduction. Control hypertension and diabetes, when present.
  • Statin therapy is recommended for adults in groups demonstrated to benefit. ASCVD risk reduction clearly outweighs the risk of adverse events based on a strong body of evidence in 4 groups:
    • Secondary prevention in individuals with clinical ASCVD
    • Primary prevention in individuals age ≥ 21 years with primary elevations of LDL-C ≥ 190 mg/dL
    • Primary prevention in individuals with diabetes 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
    • Primary prevention in individual without diabetes and with estimated 10-year ASCVD risk ≥ 7.5%, 40 to 75 years of age who have LDL-C 70 to 189 mg/dL
  • Statins have an acceptable margin of safety when used in properly selected individuals and appropriately monitored. If no baseline abnormality, monitoring of hepatic transaminases is not routinely needed. CK should not be routinely measured unless there is a personal or family history of muscle problems. You may need to discontinue and then restart the statin to determine the cause of muscle symptoms.
  • Engage in a clinician-patient discussion before initiating statin therapy, especially for primary prevention. Discuss the potential for ASCVD event reduction, adverse effects, drug–drug interactions, and patient preferences. Additional factors may be considered when a risk-based decision is uncertain.
    • These include LDL-C ≥ 160 mg/dL, family history of premature ASCVD, hs-CRP ≥ 2.0 mg/L, CAC ≥ 300 Agatson units, ABI < 0.9; lifetime risk of ASCVD.
  • Use the newly developed Pooled Cohort Equations for estimating 10-year ASCVD risk. Calculating the estimated 10-year ASCVD risk should be the start of the clinician-patient discussion and should not automatically lead to statin initiation.
    • For other ethnic groups, use the equations for non-Hispanic whites, although these estimates may underestimate the risk for persons from some race/ethnic groups, especially American Indians, some Asian Americans (e.g., of south Asian ancestry), and some Hispanics (e.g., Puerto Ricans), and may overestimate the risk for others, including some Asian Americans (e.g., of east Asian ancestry) and some Hispanics (e.g., Mexican Americans).
  • Initiate the appropriate intensity of statin therapy to reduce ASCVD risk.
  • Evidence is inadequate to support treatment to specific LDL-C or non–HDL-C treatment goals. “Treating to goal” may result in treatment with less-than-optimum statin intensity or adding unproven nonstatin therapy.
  • Regularly monitor patients for adherence to lifestyle and appropriate intensity of statin therapy. Obtain a fasting lipid panel before and after initiating statin or other drug therapy.
  • Nonstatin drug therapy may be considered in selected individuals.”

Going Lo-Co GLOSSARY:

  • ASCVD -atherosclerotic cardiovascular disease
  • Hypertension – high blood pressure
  • Statin Therapy – treatment with statin drugs, like Lipitor
  • Individuals with clinical ASCVD  – people with cardiovascular disease or who have had a ‘cardiac event’ like a heart attack
  • LDL-C – level of LDL cholesterol in the blood
  • 10 year ASCVD risk – risk of a cardiac event in 10 years, as measured by the calculator issued with the November 2013 guidelines.  More here: Going LoCo Calculator Post
  • hs-CRP – measure of “C-Reactive Protein” which is a marker for inflammation
  • CAC – coronary artery calcium which measures the thickness of fatty accumulation in the arteries and is used to predict heart disease risk

While managing cholesterol down to a specific goal is no longer the treatment standard, that doesn’t mean you shouldn’t be tracking your cholesterol and managing non-dangerous/risky high cholesterol with lifestyle choices. And remember, if your LDL cholesterol is at/over 190 mg/dL or you have other risks, discuss a statin with your doctor.

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