Abstract:To the Editor: Keaney et al. (Jan. 16 issue)1 succinctly summarize part of the 2013 guidelines of the American College of Cardiology–American Heart Association (ACC-AHA) for the treatment of high bloo...To the Editor: Keaney et al. (Jan. 16 issue)1 succinctly summarize part of the 2013 guidelines of the American College of Cardiology–American Heart Association (ACC-AHA) for the treatment of high blood cholesterol levels.2 Unfortunately, the authors omitted the three key recommendations that make these guidelines truly pragmatic. First, assessment of the 10-year risk of atherosclerotic cardiovascular disease is only the starting point. A clinician and patient must discuss the potential for benefit with respect to reduction of this risk, adverse effects, and patient preferences before initiating the use of a statin for primary prevention. Second, moderate-intensity statin therapy may be initiated when the 10-year risk of atherosclerotic cardiovascular disease is 5.0 to less than 7.5%. And third, when a risk-based decision is uncertain, additional factors that may increase the risk of atherosclerotic cardiovascular disease can be considered. If these three key recommendations are ignored, the recommendations by Keaney et al. differ from the guidelines. The objective of the guideline panel, of which one of us was the chair and two of us were vicechairs, was to recommend statin therapy for patients who are most likely to benefit and to identify those who are less likely to benefit. We emphasize that guidelines can inform clinical judgment but do not replace it, especially in primary prevention. Neil J. Stone, M.D.Read More
Publication Year: 2014
Publication Date: 2014-05-15
Language: en
Type: article
Access and Citation
Cited By Count: 11
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