Key result
The authors propose four modifications to the 2019 AHA/ACC guidelines: aiming for 100% eradication of atherosclerosis, recognizing its reversibility, targeting LDL-C <50 mg/dl, and expanding CAC use.
Why the study?
Because guidelines rely on limited published studies and expert consensus, omissions and errors occur, prompting the identification of areas where alternative approaches could improve outcomes.
The authors argue that the 2019 AHA/ACC primary prevention guidelines should be updated to target an LDL-C <50 mg/dL and recommend widespread CAC scanning to achieve total eradication of atherosclerosis.
Challenges 2019 AHA/ACC targets with LDL-C <50 mg/dl and expanded CAC; extends debate on atherosclerosis eradication but requires prospective validation.
The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease for treatment of atherosclerosis in asymptomatic individuals is an advance over previously published recommendations. However, since all guidelines are based on a limited quantity of published studies and result from a consensus of experts in different fields of medicine, omissions and errors are inevitable. The present manuscript identifies four areas in these 2019 AHA/ACC guidelines that alternative approaches or changes would result in improved outcomes and reductions in atherosclerotic events. First, the goal for the reduction in the prevalence of cardiovascular disease should be total (100%) eradication of the disease. This is a feasible goal as the facilities and resources to accomplish this task are currently available. Second, guidelines should acknowledge that atherosclerosis is a reversible disease as has previously been documented by multiple studies. If reversible, then under the appropriate clinical circumstances, it is preventable. Third, the goal for LDL cholesterol reduction should be <50 mg/dl, if eradication of atherosclerosis is to be achieved. This goal is achievable and safe as suggested by published studies. Fourth, widespread use of the coronary artery calcium scan needs to be recommended so that early atherosclerosis can be reversed before a major cardiovascular event occurs. Treating all individuals at a specific risk category without regard for the presence of disease results in poor adherence to therapy and unnecessary side effects. Consideration of these four issues would improve the AHA/ACC guidelines and result in better patient care.
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Schade et al. (2020) conducted an editorial in Atherosclerotic cardiovascular disease. 2019 AHA/ACC Cardiovascular Guidelines modifications was evaluated. The authors propose four modifications to the 2019 AHA/ACC guidelines: aiming for 100% eradication of atherosclerosis, recognizing its reversibility, targeting LDL-C <50 mg/dl, and expanding CAC use.
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