New AHA/ACC cholesterol guideline recommends use of new drugs

Guideline updates 2013 recommendation for managing cholesterol in patients

The American Heart Association (AHA) and the American College of Cardiology (ACC) released a new guideline for the management of cholesterol. The guideline, announced this weekend at AHA’s annual meeting, updates the 2013 guideline and emphasizes a more intensive approach to cholesterol management based on recent studies and expert consensus. 

Not only does the updated guideline call for a more personalized assessment of risk for patients, but it recommends new cholesterol lowering medications for those patients who are at the greatest risk. 

Maximally tolerated statin use is recommended to reduce LDL-C levels by 50% in patients who have atherosclerotic cardiovascular disease (ASCVD). But in cases when statins are not working and the patient is high risk, the guideline endorses two new drugs that have been developed since the 2013 cholesterol guideline. Statins in combination with ezetimibe should be used. If that fails, the guideline calls for the use of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor. However, it’s noted in the guideline that PCSK9 inhibitors lack any long-term safety data and are likely cost-prohibitive to patients. Evolocumab (Repatha—Amgen) and alirocumab (Praluent) both launched in 2015 with a list price of more than $14,000 a year. Both manufacturers have since cut that price by about one-half. 

The guideline stresses a healthy diet and exercise as the primary intervention for patients who do not fall into these categories. 

Twlug has signed on in support of the guideline and is listed in the guideline , published in the Journal of the American College of Cardiology.