New guideline on Treatment of Blood Cholesterol to

New guideline on Treatment of Blood Cholesterol to reduce ASCVD risk

Points of New ATP iv guidlines Focus on ASCVD risk reduction New perspective on LDL-C & Non-HDL-C treatment goals Global risk assesment for Primary prevention Safety recommendation Role of Biomarkers and Non-invasive tests Future updates to the blood cholesterol guidelines

10 year ASCVD risk http: //tools. acc. org/ASCVD-Risk. Estimator/#page_recommendation

Focus on ASCVD risk reduction Classified into 4 statin benefit groups: 1. Individuals with clinical ASCVD 2. Individuals with primary elevation of LDL–C > 190 mg/dl 3. Individuals 40 - 75 years of age with diabetes with LDL-C 70189 mg/dl 4. Individuals without clinical ASCVD or diabetes who are 40 – 75 years of age with LDL-C 70 -189 mg/dl and an estimated 10 year ASCVD risk of 7. 5 % or higher.

Statin therapy for ASCVD risk reduction

Statin therapy in individual with clinical ASCVD

Statin therapy in individiual without clinical ASCVD

Role of Biomarkers and Non-invasive tests For treatment decision in selected individuals who are not included in the 4 statin benefit groups.

Other factors: 1. Primary LDL-C > 160 mg/dl 2. Genetic hyperlipidemias 3. <55 years of age in first degree male relative or < 65 years of age in first degree female relative 4. C-reactive protein > 2 mg/dl 5. Ankle brachial index < 0. 9 6. Elevated lifetime risk of ASCVD

New perspective on LDL-C & Non. HDL-C treatment goals Appropriate intensity of statin therapy should be used. benefits compared to their adverse effects in routine prevention of ASCVD.

Non-Statin drug therapy • Niacin • Bile acid sequestrants : cholestyramine, colestepol , colesevalam • Fibric acid derivatives: gemfibrozil, fenofibrate, clofibrate

Safety recommendation Identifies important safety considerations Facilitates understanding of the net benefit from statin therapy Provides guidance on management of statin associated adverse effects

Monitoring of therapeutic responce

Secondary causes

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