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Deciphering the New Guidelines

Deciphering the New Guidelines. b y Apurva D. Shah, FACC Northside Heart and Vascular Institute. 2013 ACC/AHA Lipid Guidelines. 8:00am Appointment. “Doc, why would you want to change my cholesterol medications?”

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Deciphering the New Guidelines

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  1. Deciphering the New Guidelines by Apurva D. Shah, FACC Northside Heart and Vascular Institute

  2. 2013 ACC/AHA Lipid Guidelines

  3. 8:00am Appointment • “Doc, why would you want to change my cholesterol medications?” • I need a trick to remember the guidelines; I can’t Google it in front of the patient • That wasn’t so bad, lets try it again on the next patient

  4. 8:00am Appointment “Doc, why would you want to change my cholesterol medications?”

  5. Doc, why do you wanna change my cholesterol medications? • The ATP III guidelines: • Assess risk based on the Framingham Risk Score • FRS underestimates cardiovascular risk • Lots of patients with low FRS have MI’s • Sets goal LDL-C levels for therapy • Clinical trials didn’t set LDL-C goals • No trial was powered for and LDL-C = 70

  6. By using the Framingham Risk Score, we are missing people who can benefit from statin therapy 10 Year Predicted and Observed Rates of CV Disease and Heart Disease Mortality Quintiles of Framingham Predicted CV Disease Events Brindle P M et al. Br J Gen Prac 2005;55:838-845

  7. Most clinical trials used fixed statin doses and did not treat to a goal LDL-C

  8. Because the FRS missed at risk patients and the trials didn’t support a goal LDL, the 2013 Lipid Guidelines were created

  9. Watch the flash We need to start from scratch

  10. 8:00am Appointment I need a trick and method to remember the guidelines that’s not Google!

  11. HOW TO APPROACH THE NEW GUIDELINES

  12. RISK GROUPS

  13. REMEMBER“ALDE”

  14. HOW TO APPROACH THE NEW GUIDELINES

  15. Fixed Statin Doses

  16. Let’s see how it works….a patient walks into your office

  17. ATHEROSCLEROTIC DISEASE • High risk for cardiovascular event • High risk requires High Intensity • Lipitor 40-80mg • Crestor 20-40mg

  18. Let’s see how it works….a patient walks into your office

  19. LDL > 190 • LDL > 190 confers a high event risk • High risk requires High intensity • Lipitor 40-80mg • Crestor 20-40mg

  20. Let’s see how it works….a patient walks into your office

  21. DIABETIC • Not all Diabetic are created equal But • All Diabetics benefit from statin therapy • Must calculate risk score

  22. RISK CALCULATOR • Found at Google Play Store: • ASCVD Risk Estimator • Estimates 10 year risk for a cardiovascular event • High risk > 7.5%

  23. DIABETIC“Deciding on Statin Intensity”

  24. Let’s see how it works….a patient walks into your office

  25. EVERYONE ELSE(No ASCVD; LDL<190; NonDiabetic)

  26. SUMMARY

  27. 8:00am Appointment That wasn’t so bad, let’s try it again on the next patient

  28. Case Study #1

  29. Case Study #2

  30. Case Study #3

  31. Case Study #4

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