Lipid society sides with LDL targets in draft guidelines

The National Lipid Association (NLA) bumped up timing of draft recommendations for managing patients with dyslipidemia, spurred by the publication of cholesterol guidelines from two cardiology societies. The two sets of guidelines agree about the use of statins but diverge over targets.

The NLA made an outline of its recommendations public May 2 and set a deadline of May 31 for public comments. Led by co-chairs Terry A. Jacobson, MD, of Emory University in Atlanta, and Matthew K. Ito, PharmD, of Oregon State University in Corvallis, the expert panel wrote that it was seeking feedback and advice from other experts and organizations before finalizing the recommendations.

In late 2013, the American Heart Association (AHA) and the American College of Cardiology (ACC) unveiled prevention guidelines designed to reduce the risk of atherosclerotic disease that veered from previous recommendations in several ways. The writers focused on evidence from clinical trials for their evaluation and recommendations, and determined that the evidence did not support the goal of targets for low-density lipoprotein (LDL) cholesterol.

Some physicians have criticized abandoning targets. Critics also took aim at a new risk estimator introduced in the AHA/ACC guidelines, arguing it may lead to over or under treatment.

In their draft, the NLA experts agree with the AHA/ACC writers about the presumed benefits of reducing LDL cholesterol through lifestyle changes and drug therapies in at-risk patients. They emphasized the need for intermediate- and long-term assessment of atherosclerotic risk and supported the use of statins in appropriate patients unless it is contraindicated. They also cautioned to consider risks associated with statin use.

Both guidelines support screening for lipid profiles. But the NLA draft retains targets of LDL cholesterol and non-high-density lipoprotein cholesterol as treatment goals, setting a goal of 130 mg/dL for low- to high-risk patients and of 100 mg/dL for those at very high risk.  

The NLA and AHA/ACC writers also recommend lifestyle changes to prevent atherosclerotic disease, being patient focused and engaging in patient-physician communication.