Evolution of lipid management guidelines: evidence might set you free.

OBJECTIVE: To understand how the new guidelines for management of cardiovascular risk by the American Heart Association and the American College of Cardiology (AHA-ACC) can be interpreted and used in a Canadian setting. SOURCES OF INFORMATION: The AHA-ACC guidelines were reviewed, along with all references. Independent PubMed searches were done to include the addition of other lipid-lowering therapy to statins and the use of medical calculators to enhance patient understanding. MAIN MESSAGE: The new AHA-ACC guidelines are based on the best current evidence related to lipid management. This includes use of 10-year cardiovascular disease (CVD) risk as the treatment threshold in place of low-density lipoprotein cholesterol levels, as well as abandonment of low-density lipoprotein treatment targets. There is increased emphasis on dietary and exercise interventions, with the beginning of an effort to quantify the effect of these interventions. Statins are the main drug intervention, and the addition of other drugs to augment lipid lowering is no longer recommended. For application in Canada, Framingham risk tables are more appropriate for risk assessment than the pooled cohort equations used in the United States. Risk calculators for CVD risk should contain information on cardiovascular age and have the ability to represent risk and alternative interventions graphically in order to improve patient understanding and promote informed decision making.
CONCLUSION: Focus on the best evidence in CVD risk can simplify lipid management for both the physician and the patient. Copyright© the College of Family Physicians of Canada.