Introduction
Adult Treatment Panel IV Guidelines were released in 2013 as the American College of Cardiology and American Heart Association (ACC/AHA) guidelines for cholesterol management in adults. These recommendations are based on the results of meta-analyses and randomized trials and are mainly focused on utilizing statin therapy at the required intensity (Robinson, 2014). The previous guideline is known to recommend such goals as non-high and low-density lipoprotein cholesterol treatment.
Major risk groups and recommendations
It is generally recognized that there is a large group of patients who might need statin therapy for cholesterol control. Observational data used to develop the given guidelines has some limitations, as well as verification, of statin appliance, including doses and statin type. ATP IV guidelines are applied for cholesterol management to improve outcomes in patients with such clinical risk categories as:
- Atherosclerotic cardiovascular disease (ASCVD) to reduce the risk of occurrence and complications by utilizing special drug therapy to low cholesterol level
- Diabetes mellitus type I and II to assist in overall disease management as an additional therapy (Ray et al., 2014)
- Patients with an increase of LDL-cholesterol up to 4.9 mmol/L and more
It is noted that statin therapy has positive results and is safe when used in prescribed individual doses with regular assessments as a part of the follow-up. The initiation of statin treatment is to be based on the preferences of patients and clinical judgments. Major recommendations for blood cholesterol management presented in the ATP IV guidelines include:
- Initiation and continuation of statin therapy of appropriate intensity with limitations to patient’s diagnosis and age
- Regular monitoring of adherence to drug therapy and lifestyle with safety and lipid assessment
- Maximally tolerated statin intensity utilized in individuals who cannot tolerate the recommended doses (Stone et al., 2014)
- Estimation of ten years of statin initiation risk for ASCVD by using pooled cohort equations developed based on recent data of population-based cohorts
Cholesterol therapy is mainly based on the potential benefit of reducing ASCVD risk. High-intensity therapy is recommended for the patients of a high-risk group, including the individuals aged up to 75 with clinical ASCVD. It might also be used for patients aged 40-75 with diabetes or without it if their LDL-cholesterol is 70-189 mg/dL (Robinson & Stone, 2015). Moderate levels of statin intensity are recommended to the patients out of safety concerns if they cannot tolerate high doses of statin.
Advantages and disadvantages
The presented guidelines are believed to provide complete cholesterol management recommendations. They include risk assessment and are based on controlled trials. It is possible to state that they include such benefits as:
- Successful prioritizing of statin therapy as the medications which can prevent mortality from such diseases as ASCVD and diabetes and improve patient’s life quality
- Expanding ASCVD focus as this disorder share risks with coronary heart disease and cerebrovascular disease
- Emphasis on cardiovascular risk in statin therapy allocation by considering patients age and disease development level (Martin et al., 2014)
Nevertheless, it is possible to say that some aspects could be covered better in the guidelines such as:
- Improving utilizing of lipids applied in the previous guideline instead of removing them
- Enhancing guidance on cholesterol level evaluation to improve risk assessment
- Broaden age concept to help patients to understand their risks better
Conclusion
A patient-centered method of treatment provided in the guidelines utilizes an evidence-based approach to reduce risks of atherosclerosis and diabetes. The recommendations for utilizing statin therapy seem to be promising for practical application. Thus, these recommendations can be applied to managing cholesterol in patients to reduce risks related to ASCVD and diabetes.
References
Martin, S. S., Abd, T. T., Jones, S. R., Michos, E. D., Blumenthal, R. S., & Blaha, M. J. (2014). 2013 ACC/AHA cholesterol treatment guideline: What was done well and what could be done better. Journal of the American College of Cardiology, 63(24), 2674-2678.
Ray, K. K., Kastelein, J. J., Matthijs Boekholdt, S., Nicholls, S. J., Khaw, K. T., Ballantyne, C. M., & Lüscher, T. F. (2014). The ACC/AHA 2013 guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: The good the bad and the uncertain: A comparison with ESC/EAS guidelines for the management of dyslipidaemias 2011. European Heart Journal, 35(15), 960-968.
Robinson, J. G. (2014). 2013 ACC/AHA cholesterol guideline for reducing cardiovascular risk: What is so controversial? Current Atherosclerosis Reports, 16(6), 413.
Robinson, J. G., & Stone, N. J. (2015). The 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk: A new paradigm supported by more evidence. European Heart Journal, 36(31), 2110-2118.
Stone, N. J., Robinson, J. G., Lichtenstein, A. H., Goff, D. C., Lloyd-Jones, D. M., Smith, S. C., & Schwartz, J. S. (2014). Treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: Synopsis of the 2013 American College of Cardiology/American Heart Association cholesterol guideline. Annals of Internal Medicine, 160(5), 339-343.