While PCSK9 inhibitors are also indicated throughout the guidelines as an effective lipid-lowering non-statin agent, particularly as add-on therapy to a statin regimen, the writing committee noted that little long-term data are available to determine their safety in patients with hypercholesterolemia.Ĭlinicians are recommended to assess for medication adherence and efficacy at 4 to 12 weeks using a fasting lipid test. Both therapies have been shown to reduce LDL-C levels by 13% to 20% and 15% to 30%, respectively, according to findings from the committee’s literature review. Low-Intensity Therapy: 10mg simvastatin or 10mg to 20mg pravastatin and 20mg lovastatin and 20mg to 40mg fluvastatinĮzetimibe is a potentially effective non-statin therapy mentioned in the report, as are bile acid sequestrants.Moderate-Intensity Therapy: 10mg atorvastatin (20mg) and 10mg rosuvastatin (5mg) and 20mg to 40mg simvastatin or 40mg pravastatin (80mg) and 40mg lovastatin (80mg) and 80mg fluvastatin XL and 40mg fluvastatin BID and pitavastatin.High-Intensity Therapy: 80mg atorvastatin (40mg: down titration if intolerable to 80mg) and 20mg rosuvastatin (40mg).Recommended statin regimens for each intensity level include: High-intensity, moderate-intensity, and low-intensity statin therapies lower LDL-C levels by ≥50%, 30% to 49%, and <30%, respectively. In addition to lifestyle interventions, statins continue to be the cornerstone of therapy for lipid management. For patients with metabolic syndrome (ie, presence of risk factors for atherosclerotic cardiovascular disease ( ASCVD), diabetes mellitus, and all-cause death), the recommended lifestyle interventions are particularly indicated. In combination with caloric adjustment, these exercise sessions can be used to reduce body weight in overweight/obese individuals while promoting healthier cholesterol control. A dietary pattern high in vegetables, fruits, lean proteins, and whole grains, as well as limits on sweets and processed fats, is recommended in the updated guidelines.Īerobic-type moderate to vigorous physical activity is recommended 3 to 4 days per week at 40 minutes per session. Recommendations for living a healthy lifestyle, comprised of eating a nutrient-dense diet and the inclusion of regular physical activity, remain a focal point of the 2018 AHA/ACC cholesterol guidelines as they were in the previously published versions. That’s why it’s so important that even at a young age, people follow a heart-heathy lifestyle and understand and maintain healthy cholesterol levels.” ![]() 2 “Having high cholesterol at any age increases that risk significantly. ![]() They build on the major shift we made in our 2013 cholesterol recommendations to focus on identifying and addressing lifetime risks for cardiovascular disease,” said Ivor Benjamin, MD, FAHA, president of the American Heart Association. ![]() ![]() “The updated guidelines reinforce the importance of healthy living, lifestyle modification, and prevention. 1 The guidelines provide new and consistent evidence-based cholesterol-lowering recommendations, including lifestyle interventions, statin and non-statin regimens, risk assessment scores and calculators, and management of specific patient populations. New cholesterol-lowering guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC), as well as several other nationally recognized health and medical organizations, were presented at the 2018 AHA Scientific Sessions held in Chicago, Illinois, November 10-12, 2018, and simultaneously published online in Circulation.
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