A controversial step forward: A commentary on the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults.

The 2013 ACC/AHA guidelines on the treatment of blood cholesterol in adults is a major step forward in the field of preventive cardiology but it is not without controversy. It should be well accepted that in individuals with established atherosclerotic vascular disease, individuals with a low-density lipoprotein cholesterol of greater than 190 mg/dl and individuals with diabetes, treatment with an appropriate fixed dose of a statin, without titration to a specific low-density lipoprotein goal, will provide substantial protection against future atherosclerotic vascular disease events. More controversial is the utilization of a risk calculator in primary care to determine which individuals will require a statin. For as long as these risk calculators are in question, primary care practitioners will struggle to make treatment decisions. Factors such as cardiovascular fitness, measures of adiposity, and details of the family history will aid in treatment decisions.