2013 ACC/AHA Guidelines: Blood Cholesterol And Assessment of Cardiovascular Risk Elena Kuklina, MD, Ph.D. Senior Service Fellow State Grantee Webinar, Hypertension, Cholesterol and Sodium Guidelines: Implications for Cardiovascular Health February 12, 2014 National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention

Background ACC/AHA published new cholesterol and cardiovascular risk assessment guidelines in This is an overview of the 2013 ACC/AHA guidelines and a comparison to preceding guidelines. 1. Goff DC, Lloyd-Jones DM, Bennett G, et al ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November ]. Circulation Accessed February 3,

ATP III Lipid and Lipoprotein Classification (The Old Familiar Classification) LDL Cholesterol (mg/dL) <100Optimal 100–129Near optimal/above optimal 130–159Borderline high 160–189High 190Very high

Old vs. New: Lifestyle Modification Old guidelines: Diet: low fat and low cholesterol New guidelines: Diet: healthy pattern DASH, USDA, AHA Diet Calorie requirements, personal and cultural preferences, and nutrition therapy for other medical conditions regular exercise habits avoidance of tobacco products maintenance of a healthy weight

Old vs. New: Statin Eligibility Old New AgeStatin eligible groups 121 yearsClinical CVD 221 yearsLDL-C 190 mg/dl years +LDL- C mg/dl Diabetes years + LDL- C mg/dL High CVD risk 7.5%, 10 years, CHD or stroke

Determining Risk for the 4 th Group New Pooled Cohort Equations to estimate 10-year risk Adults years of age who are free from ASCVD 4 racially and geographically diverse cohorts ASCVD risk: heart disease and stroke Calculated from sex, age, race, total cholesterol, HDL cholesterol, systolic blood pressure, and whether on treatment for high blood pressure, has diabetes, or is a smoker See Flowchart (addendum)

New: Classification of Statin Intensity Intensity of statin therapy: is defined as a daily dose that lowers LDL-C by High-intensity: by 50% Moderate-intensity: by 30% to <50%

New: Intensity Instead of Levels

What about the Rest? There are people who may benefit from statin therapy who do not fall into one of the four groups. As with other guidelines, clinicians may use their judgment in considering other factors such as: family history of ASCVD. biomarkers such as C - reactive protein. ankle-brachial index, etc.

Summary Statin is the first line therapy. Statin eligible groups based on benefit, not only on the LDL- C measurement. Treatment is based on statin intensity instead of specific treatment goals for blood cholesterol. New global risk assessment tool.

Healthy Dietary Patterns (servings per day unless specified) (2000 kcal)

Implications High cholesterol is a major and controllable risk factor for heart attacks and strokes. One goal of the ACC/AHA guidelines is to better identify and focus statin therapy on those who are most at risk for (or have) ASCVD.

Implications We have much room for improvement for increasing the level of healthy lifestyles and statin therapy even among those most at risk. We can use the guidelines to identify those who do not yet know they are at risk, and increase healthy lifestyle choices and statin therapy for those who are.

Program Considerations New performance measures for cholesterol are in the development phase. Right now, we can: Increase adaptation of healthy lifestyle and levels statin therapy for those who do know they are at risk. Help them adhere to that therapy for the rest of their longer lives.

Sources Goff DC, Lloyd-Jones DM, Bennett G, et al ACC/AHA Guideline on the Assessment of Cardiovascular Risk: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November ]. Circulation on. Accessed February 3, on Stone NJ, Robinson J, Lichtenstein AH, et al ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published online ahead of print November ]. Circulation on. Accessed February 3, on Journal of American College of Cardiology Accessed February 3, 2014

Education materials for patients Getting Healthy by AHA: Healthy_UCM_001078_SubHomePage.jsp Healthy_UCM_001078_SubHomePage.jsp Chose my plate by USDA: Lowering your blood pressure with DASH by NIH topics/topics/dash/ topics/topics/dash/

Thank you! For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone: CDC-INFO ( )/TTY: Visit: | Contact CDC at: CDC-INFO or The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion Division for Heart Disease and Stroke Prevention