Adherence to Newer Lipid Guidelines
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Publication Date
2025
Keywords
oregon, oaa 2025
Disciplines
Medical Education | Pharmacy and Pharmaceutical Sciences
Abstract
Abstract: The American College of Cardiology (ACC)/American Heart Association (AHA) 2018 cholesterol guidelines provided recommendations for lipid lowering therapy in patients with clinical atherosclerotic cardiovascular disease (ASCVD) and very high risk ASCVD. The guidelines recommended reducing low-density lipoprotein cholesterol (LDL-C) by > 50% in patients with clinical ASCVD, however, there was little guidance for tar-geting a specific LDL-C measurement. Since the ACC/AHA 2018 cholesterol guidelines were published, newer guidelines, with more aggressive LDL-C targets have been published – specifically, the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) 2019 Dyslipidemia guidelines and ESC 2021 Cardiovascular (CV) Disease Prevention guidelines. These updates further identify patients who should be considered for tighter LDL-C target goals. Patients identified with clinical ASCVD and very high risk ASCVD should have a target LDL-C < 55 mg/dL. Additionally, patients with > 2 CV events within 2 years of max tolerated statin therapy should have an LDL-C target < 40 mg/dL. Patient’s at very high risk ASCVD are defined as follows: • Severe CKD (eGFR < 30 mL/min/1.73 m2 or eGFR 30-44 mL/min/1.73 m2 and albu-min-to-creatinine ratio (ACR) > 30) • Patients with type 1 or type 2 diabetes mellitus with established ASCVD and/or severe target organ damage: eGFR < 45 mL/min/1.73 m2 irrespective of albuminuria eGFR 45-59 mL/min/1.73 m2 and microalbuminuria (ACR 30-300 mg/g) Proteinuria (ACR > 300 ng/g) Presence of microvascular disease in at least 3 different sites (e.g., microal-buminuria + retinopathy + neuropathy) • Patients with established ASCVD: Documented ASCVD, clinical or unequivocal im-aging. Documented clinical ASCVD includes previous AMI, ACS, coronary revas-cularization and other arterial revascularization procedures, stroke and TIA, aortic aneurysm and PAD. Unequivocal documented ASCVD on imaging includes plaque on coronary angiography or carotid ultrasound or on CTA. • SCORE2 or SCORE2-OP CVD risk score < 50 years old and score > 7.5% 50-69 years old and score > 10% > 70 years old and score > 15% Providers have received various education(s) throughout the years via continuing education, ACC/AHA and EAS/ESC communications, in-house service, etc. regarding lipid lowering therapy. Anecdotally, it seems that most providers are still practicing according to the ACC/AHA 2018 cholesterol guidelines. The purpose of this project is to assess and identify gaps in current clinical practice regarding lipid lowering therapy. Eventually, we may develop a stepwise approach for lipid lowering therapy.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Pharmacy
