New blood cholesterol lowering guidelines were recently released by the American Heart Association and the American College of Cardiology.   This is the first update in these guidelines since their last release in 2013.  Major changes to the guidelines include the addition of new drugs that were not available in 2013, ezitimbe and PCSK9-Inhibitors.  These agents are added to statin therapy for both primary and  secondary prevention of acute cardiovascular disease in patients unable reduce LDL-C to target goals.  The guidelines also recommend shared decision making and a more personalized approach.  Healthy lifestyle is emphasized for all patients, from childhood onward.  The guidelines also recommend that healthy individuals ages 40-75, with LDL > 70 to <190, without diabetes, should have their 10 year risk of ASCVD assessed and use this information to inform LDL-C goals.   In addition to traditional risk factors such as smoking, hypertension and diabetes, the new guideline adds factors like family history and ethnicity, as well as certain health conditions such as metabolic syndrome, chronic kidney disease, chronic inflammatory conditions, premature menopause or pre-eclampsia and high lipid biomarkers, to  better determine individualized risk and treatment options. The guidelines also define responses to lifestyle and statin therapy by percentage reductions in LDL-C levels compared to baseline.

2018 Guideline on the Management of Blood Cholesterol

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