Curr Atheroscler Rep (2015) 17:15 DOI 10.1007/s11883-015-0494-9
CORONARY HEART DISEASE (E GIANOS AND B SHAH, SECTION)
The Recent National Lipid Association Recommendations: How Do They Compare to Other Established Dyslipidemia Guidelines? Laura Flink & James A. Underberg & Jonathan D. Newman & Eugenia Gianos
# Springer Science+Business Media New York 2015
Abstract The National Lipid Association (NLA) recently released recommendations for the treatment of dyslipidemias. These recommendations have commonalities and differences with those of other major societies with respect to risk assessment, lifestyle therapy, targets of therapy, and the use of nonstatin agents. In this review, we compare the basic elements of the guidelines from each major society to provide clinicians with a comprehensive document reviewing the key principles of each. Keywords Lipid guidelines . Dyslipidemia . Cholesterol treatment . Atherosclerotic cardiovascular disease risk . This article is part of the Topical Collection on Coronary Heart Disease L. Flink : J. D. Newman : E. Gianos Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York University Medical Center, 530 First Avenue, Schwartz 4F, New York, NY 10016, USA L. Flink e-mail: [email protected] J. D. Newman e-mail: [email protected] J. A. Underberg Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University Medical Center, 317 East 34th street, Floor 7, New York, NY 10016, USA e-mail: [email protected]
Risk calculator . National Lipid Association . International Atherosclerosis Society . The American Association of Clinical Endocrinologists . The American College of Cardiology/American Heart Association
Introduction Over the past few years, several major societies have proposed guidelines and recommendations for dyslipidemia treatment to prevent atherosclerotic cardiovascular disease (ASCVD). The most recent dyslipidemia management recommendations were released by the National Lipid Association (NLA) Expert Panel in September 2014. Recommendations from multiple major societies provide a large amount of information for clinicians to review and incorporate into clinical practice. Although there are many commonalities, some of the risk assessment and management algorithms differ between major societies. This can create confusion and uncertainty for clinicians. The purpose of this review is to provide a brief summary of each set of guidelines and recommendations and to compare the recent NLA recommendations for management of dyslipidemia with those of the other major societies (International Atherosclerosis Society (IAS) 2013 recommendations, the American Association of Clinical Endocrinologists (AACE) 2012 guidelines, and the American College of Cardiology/ American Heart Association (ACC/AHA) 2013 guidelines).
J. D. Newman Division of Cardiology, Department of Medicine, New York University School of Medicine, New York University Medical Center, 227 E. 30th St., TRB Room 853, New York, NY 10016, USA
National Lipid Association 2014 Recommendations
E. Gianos (*) Division of Cardiology, Department of Medicine, New York University School of Medicine, New York University Medical Center, 530 First Avenue, Schwartz 4F, New York, NY 10016, USA e-mail: [email protected]
The NLA Expert Panel in its recent recommendations emphasizes that an elevated level of apolipoprotein-B (apo B) containing lipoproteins (non-high-density lipoprotein-cholesterol (non-HDL-C) and low-density lipoprotein-cholesterol (LDL-
15
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C)) is a crucial component in the development of atherosclerosis and contributes to most atherosclerotic cardiovascular disease (ASCVD) events [1••]. The panel states that reduction in levels of these lipoproteins will reduce ASCVD risk, and lifestyle therapies are emphasized for risk reduction. The panel concludes that statins should be used as the principle drug class for lipid lowering in efforts to reduce ASCVD risk and that statin intensity should be adjusted based on the risk category. Who and When to Screen The NLA panel recommends that a lipoprotein profile be obtained in adults aged 20 years and older. If in the desirable range (discussed below), lipoprotein measurement as well as ASCVD risk assessment should be repeated every 5 years or sooner if considered necessary. Risk Assessment The NLA panel recommends risk categorization based on major ASCVD risk factors to inform treatment targets for lipid therapy. These risk factors are defined as age (men ≥45 years, women ≥55 years), family history of early coronary artery disease (CAD) (
CORONARY HEART DISEASE (E GIANOS AND B SHAH, SECTION)
The Recent National Lipid Association Recommendations: How Do They Compare to Other Established Dyslipidemia Guidelines? Laura Flink & James A. Underberg & Jonathan D. Newman & Eugenia Gianos
# Springer Science+Business Media New York 2015
Abstract The National Lipid Association (NLA) recently released recommendations for the treatment of dyslipidemias. These recommendations have commonalities and differences with those of other major societies with respect to risk assessment, lifestyle therapy, targets of therapy, and the use of nonstatin agents. In this review, we compare the basic elements of the guidelines from each major society to provide clinicians with a comprehensive document reviewing the key principles of each. Keywords Lipid guidelines . Dyslipidemia . Cholesterol treatment . Atherosclerotic cardiovascular disease risk . This article is part of the Topical Collection on Coronary Heart Disease L. Flink : J. D. Newman : E. Gianos Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York University Medical Center, 530 First Avenue, Schwartz 4F, New York, NY 10016, USA L. Flink e-mail: [email protected] J. D. Newman e-mail: [email protected] J. A. Underberg Department of Medicine, Center for the Prevention of Cardiovascular Disease, New York University Medical Center, 317 East 34th street, Floor 7, New York, NY 10016, USA e-mail: [email protected]
Risk calculator . National Lipid Association . International Atherosclerosis Society . The American Association of Clinical Endocrinologists . The American College of Cardiology/American Heart Association
Introduction Over the past few years, several major societies have proposed guidelines and recommendations for dyslipidemia treatment to prevent atherosclerotic cardiovascular disease (ASCVD). The most recent dyslipidemia management recommendations were released by the National Lipid Association (NLA) Expert Panel in September 2014. Recommendations from multiple major societies provide a large amount of information for clinicians to review and incorporate into clinical practice. Although there are many commonalities, some of the risk assessment and management algorithms differ between major societies. This can create confusion and uncertainty for clinicians. The purpose of this review is to provide a brief summary of each set of guidelines and recommendations and to compare the recent NLA recommendations for management of dyslipidemia with those of the other major societies (International Atherosclerosis Society (IAS) 2013 recommendations, the American Association of Clinical Endocrinologists (AACE) 2012 guidelines, and the American College of Cardiology/ American Heart Association (ACC/AHA) 2013 guidelines).
J. D. Newman Division of Cardiology, Department of Medicine, New York University School of Medicine, New York University Medical Center, 227 E. 30th St., TRB Room 853, New York, NY 10016, USA
National Lipid Association 2014 Recommendations
E. Gianos (*) Division of Cardiology, Department of Medicine, New York University School of Medicine, New York University Medical Center, 530 First Avenue, Schwartz 4F, New York, NY 10016, USA e-mail: [email protected]
The NLA Expert Panel in its recent recommendations emphasizes that an elevated level of apolipoprotein-B (apo B) containing lipoproteins (non-high-density lipoprotein-cholesterol (non-HDL-C) and low-density lipoprotein-cholesterol (LDL-
15
Page 2 of 9
C)) is a crucial component in the development of atherosclerosis and contributes to most atherosclerotic cardiovascular disease (ASCVD) events [1••]. The panel states that reduction in levels of these lipoproteins will reduce ASCVD risk, and lifestyle therapies are emphasized for risk reduction. The panel concludes that statins should be used as the principle drug class for lipid lowering in efforts to reduce ASCVD risk and that statin intensity should be adjusted based on the risk category. Who and When to Screen The NLA panel recommends that a lipoprotein profile be obtained in adults aged 20 years and older. If in the desirable range (discussed below), lipoprotein measurement as well as ASCVD risk assessment should be repeated every 5 years or sooner if considered necessary. Risk Assessment The NLA panel recommends risk categorization based on major ASCVD risk factors to inform treatment targets for lipid therapy. These risk factors are defined as age (men ≥45 years, women ≥55 years), family history of early coronary artery disease (CAD) (
