2013 ACC/AHA Guidelines Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

Principali novità metodologiche “This guideline focuses on treatments proven to reduce ASCVD events. It does not, and was never intended to be, a comprehensive approach to lipid management” “Recommendations were derived from randomized trials, meta-analyses, and observational studies evaluated for quality, and were not formulated when sufficient evidence was not available” “ [...] as opposed to an extensive compendium of clinical information, these documents are significantly more limited in scope and focus on selected CQs in each topic [...]”

Principali novità metodologiche Clinical Questions CQ1: What is the evidence for LDL–C and non-HDL–C goals for the secondary prevention of ASCVD? CQ2: LDL–C and Non-HDL–C Goals in Primary Prevention CQ3: Efficacy and Safety of Cholesterol-Lowering Medications

Principali novità metodologiche Expert Panel Organization

Who and how to treat with statins to reduce ASCVD risk?

Who and how to Treat ‘Treat to LDL-C target’ ATP III ESC/EAS 2011

Who and how to Treat ‘The Lower The Better’

How to treat? ACC/AHA 2013 Strategies for using drug therapy to reduce ASCVD events have been advocated, including treat-to-cholesterol target, lower cholesterol is better, and risk-based treatment approaches. However, only 1approach has been evaluated in multiple RCTs – the use of fixed doses of cholesterol-lowering drugs toreduce ASCVD risk. Because the overwhelming body of evidence came from statin RCTs, the Expert Panel appropriately focused on these statin RCTs

Who to treat? ACC/AHA 2013 Identification of 4 Statins Benefits Groups Individual with clinical ASCVD (Arteriosclerotic CardioVascular Disease). Individual with primary LDL-c ≧ 190 mg/dl Diabetes aged 40 to 75 ys with LDL-c 70 to 189 mg/dl Individual with an estimated 10ys risk of ASCVD ≧ 7,5%

How to treat? - Prevenzione Secondaria ACC/AHA 2013

How to treat? - Prevenzione Primaria ACC/AHA 2013

How to treat? - Prevenzione Primaria ACC/AHA 2013

Safety

Safety

Application of New Cholesterol Guidelines to a Population-Based Sample

Application of New Cholesterol Guidelines to a Population-Based Sample

Application of New Cholesterol Guidelines to a Population-Based Sample

Application of New Cholesterol Guidelines to a Population-Based Sample

Nuove linee guida ACC/AHA Comunicato congiunto ANMCO, FIC, SIC e SISA L'approccio pragmatico di disegnare le strategie di prevenzione cardiovascolare basandosi solo sui criteri utilizzati in studi controllati e randomizzati, può limitarne l'efficacia.

Nuove linee guida ACC/AHA Comunicato congiunto ANMCO, FIC, SIC e SISA Potenziali problemi derivanti dall’assenza di target: Riduzione dell’utilizzo di terapie on top alle statine, Difficoltà di gestione, Riduzione della compliance Per la popolazione europea si continua a raccomandare l'utilizzo delle tabelle SCORE o di tabelle nazionali calibrate sullo SCORE. EAS/ESC hanno un approccio più ampio sulla dislipidemia in generale Le linee guida EAS/ESC hanno funzionato bene in Europa. Sono state ampiamente accettate e adottate e, sulla base della discussione di cui sopra, EAS e ESC le raccomandano come più adatte per l'Europa.

STRATEGIE DI PREVENZIONE CARDIOVASCOLARE EAS/ESC e ATPIII 1. "treat to target", preferibilmente con le statine 2. controllare la sindrome metabolica ACC/AHA 2013 1. combattere la "malattia obesità" 2. Statins, "come rain or come shine"