Cholesterol Management – Understanding the 2018 Guideline – Nurse Practitioner

The latest issue of The Rx Consultant is a primer for the 2018 ACC-AHA Cholesterol Management guideline for patients with high cholesterol. It summarizes new recommendations and includes a broader, more comprehensive approach to patient management. An estimated 56 million people in the US over the age of 40 years old have an indication for statin therapy. The new guideline stresses atherosclerotic cardiovascular disease (ASCVD) risk reduction strategies, including those for special populations such as children/adolescents, older adults, women, certain ethnic groups, and patients with chronic kidney disease, inflammatory disorders, HIV, or elevated triglycerides. Patients with high cholesterol need to know their ASCVD risk - and they need advice about lifestyle changes that can reduce this risk, appropriate doses of statins, and counseling regarding statin side effects. Cardiovascular disease (CVD), which includes high blood pressure, stroke, heart failure, and coronary heart disease, is prevalent and costly. Coronary heart disease is the most common form, accounting for 43% of all deaths attributed to CVD. The underlying pathophysiology of CVD is atherosclerosis; hence the term atherosclerotic cardiovascular disease (ASCVD). Risk factor management and treatment are essential to prevent CVD progression, cardiovascular events, and costly healthcare. It is important for both prescribers and pharmacists to educate patients about a heart healthy lifestyle and promote adherence to drug therapy to prevent disease progression and lower the costs associated with CVD. In November 2018, the American College of Cardiology and the American Heart Association (ACC/AHA) cholesterol guideline was published online. The writing committee included physicians from several specialty areas, pharmacists, a nurse practitioner, a physician assistant, and a layperson. In addition to the ACC/AHA, the writing committee included representatives from 10 other national organizations. The guideline provides an evidence-based and patient-centered approach to the assessment and treatment of ASCVD. The 2018 guideline builds on many of the concepts introduced in the 2013 ACC/AHA cholesterol guideline, including the emphasis on using a high- or moderate-intensity statin as first-line therapy based on patient risk, the use of the 10-year ASCVD risk estimator for certain patients (Figure 1), measuring lipids to monitor response to therapy and adherence, and the patient-clinician discussion...