New Studies Do Not Challenge the American College of Cardiology/American Heart Association Lipid Guidelines

Ideas and Opinions17 May 2016New Studies Do Not Challenge the American College of Cardiology/American Heart Association Lipid GuidelinesTimothy P. Hofer, MD, MSc, Jeremy B. Sussman, MD, MSc, and Rodney A. Hayward, MDTimothy P. Hofer, MD, MScFrom Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, and University of Michigan, Ann Arbor, Michigan., Jeremy B. Sussman, MD, MScFrom Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, and University of Michigan, Ann Arbor, Michigan., and Rodney A. Hayward, MDFrom Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, and University of Michigan, Ann Arbor, Michigan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M15-2428 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The 2013 lipid guidelines from the American College of Cardiology and the American Heart Association broke from earlier guidelines by focusing on cardiovascular risk rather than low-density lipoprotein (LDL) cholesterol levels or targets to guide lipid treatment. However, many have called for a return to LDL cholesterol targets, citing recent evidence that nonstatin lipid-lowering medications can also reduce cardiovascular outcomes (1, 2). This evidence includes IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), which found that adding ezetimibe to statin therapy decreased cardiovascular events by 6% to 7% in patients with acute coronary syndrome (3). In addition, clinical trials ...References1. Steenhuysen J, Berkrot B. New data fuels doctors' demands to rewrite U.S. heart guidelines. Reuters. 21 November 2014. Accessed at http://in.reuters.com/article/2014/11/21/us-health-heart-cholesterol-idINKCN0J50E320141121 on 22 November 2014. Google Scholar2. Beasley D, Pierson R. Pharmacy benefit manager CVS urges rewrite for U.S. heart guidelines. Reuters. 10 August 2015. Accessed at www.reuters.com/article/2015/08/10/us-health-cholesterol-cvs-idUSKCN0QF1RY20150810 on 27 August 2015. Google Scholar3. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, et al; IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015;372:2387-97. [PMID: 26039521] doi:10.1056/NEJMoa1410489 CrossrefMedlineGoogle Scholar4. Navarese EP, Kolodziejczak M, Schulze V, Gurbel PA, Tantry U, Lin Y, et al. Effects of proprotein convertase subtilisin/kexin type 9 antibodies in adults with hypercholesterolemia: a systematic review and meta-analysis. Ann Intern Med. 2015;163:40-51. [PMID: 25915661]. doi:10.7326/M14-2957 LinkGoogle Scholar5. Sussman J, Vijan S, Hayward R. Using benefit-based tailored treatment to improve the use of antihypertensive medications. Circulation. 2013;128:2309-17. [PMID: 24190955] doi:10.1161/CIRCULATIONAHA.113.002290 CrossrefMedlineGoogle Scholar6. Kent DM, Hayward RA. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. JAMA. 2007;298:1209-12. [PMID: 17848656] CrossrefMedlineGoogle Scholar7. Hayward RA. Moneyball, gambling, and the new cholesterol guidelines. Circ Cardiovasc Qual Outcomes. 2014;7:311-4. [PMID: 24594549] doi:10.1161/CIRCOUTCOMES.114.000876 CrossrefMedlineGoogle Scholar8. Vijan S, Sussman JB, Yudkin JS, Hayward RA. Effect of patients' risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern Med. 2014;174:1227-34. [PMID: 24979148] doi:10.1001/jamainternmed.2014.2894 CrossrefMedlineGoogle Scholar9. Sauser K, Levine DA, Hayward RA. A review of the clinical evidence related to early treatment of elevated LDL for cardiovascular primary prevention. Evid Based Med. 2015;20:162-9. [PMID: 26173413] doi:10.1136/ebmed-2015-110170 CrossrefMedlineGoogle Scholar10. Hayward RA, Krumholz HM, Zulman DM, Timbie JW, Vijan S. Optimizing statin treatment for primary prevention of coronary artery disease. Ann Intern Med. 2010;152:69-77. [PMID: 20083825]. doi:10.7326/0003-4819-152-2-201001190-00004 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Veterans Affairs Center for Clinical Management Research, Health Services Research and Development Service Center of Innovation, and University of Michigan, Ann Arbor, Michigan.Financial Support: Drs. Hofer and Hayward are supported by the Michigan Center for Diabetes Translational Research (National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health [P60 DK-20572]). Dr. Sussman is supported by a Veterans Affairs Health Services Research and Development Service Career Development Award.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2428.Corresponding Author: Timothy P. Hofer, MD, MS, Veterans Affairs Center for Clinical Management Research, Institute for Health Policy and Innovation, North Campus Research Complex, Building 16-328W, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800; e-mail, [email protected]edu.Current Author Addresses: Drs. Hofer and Sussman: Veterans Affairs Center for Clinical Management Research, Institute for Health Policy and Innovation, North Campus Research Complex, Building 16-328W, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800.Dr. Hayward: Director, National Clinician Scholars Program, Institute for Health Policy and Innovation, North Campus Research Complex, Building 10, Room G016, 2800 Plymouth Road, SPC 2800, Ann Arbor, MI 48109-2800.Author Contributions: Conception and design: T.P. Hofer, J.B. Sussman, R.A. Hayward.Analysis and interpretation of the data: R.A. Hayward.Drafting of the article: T.P. Hofer.Critical revision of the article for important intellectual content: T.P. Hofer, J.B. Sussman, R.A. Hayward.Final approval of the article: T.P. Hofer, J.B. Sussman, R.A. Hayward.Statistical expertise: R.A. Hayward.This article was published at www.annals.org on 9 February 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNew Studies Do Not Challenge the American College of Cardiology/American Heart Association Lipid Guidelines Timothy P. Hofer and Rodney A. Hayward New Studies Do Not Challenge the American College of Cardiology/American Heart Association Lipid Guidelines Thomas F. 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Whayne Jr, MD, PhD 17 May 2016Volume 164, Issue 10Page: 683-684KeywordsCardiovascular therapyCholesterolClinical trialsHeartHypercholesterolemiaLipidsLow density lipoproteinStatinsTreatment guidelinesVeteran care ePublished: 9 February 2016 Issue Published: 17 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...