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

Presentazione sul tema: "2013 ACC/AHA Guidelines Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults."— Transcript della presentazione:

1 2013 ACC/AHA Guidelines Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

2 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 [...]”

3 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

4 Principali novità metodologiche Expert Panel Organization

5

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

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

8 Who and how to Treat ‘The Lower The Better’

9 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

10 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%

11 How to treat? - Prevenzione Secondaria ACC/AHA 2013

12 How to treat? - Prevenzione Primaria ACC/AHA 2013

13 How to treat? - Prevenzione Primaria ACC/AHA 2013

14 Safety

15 Safety

16 Application of New Cholesterol Guidelines to a Population-Based Sample

17 Application of New Cholesterol Guidelines to a Population-Based Sample

18 Application of New Cholesterol Guidelines to a Population-Based Sample

19 Application of New Cholesterol Guidelines to a Population-Based Sample

20 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.

21 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.

22 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"