The New ACC/AHA Cardiovascular Risk Guidelines: Impact and Controversies

[摘要] The new American College of Cardiology/American Heart Association (ACC/AHA)2 guidelines for cardiovascular disease (CVD) risk assessment and treatment (1), released >6 months ago, have engendered much controversy. A recent New England Journal of Medicine article (2) has estimated the impact of the new guidelines on the use of statins in the US. Extrapolating from the National Health and Nutrition Examination Survey population, the new guidelines could result in treating approximately 56 million Americans with statins, or 12.8 million more people than would have been treated according to the older Adult Treatment Panel III (ATP-III) guidelines (3). Approximately half the population between the ages of 40 and 75 years would be eligible for statins under the new guidelines, compared with about 37.5% under ATP-III. Given that CVD accounts for about a third of all mortality, and that the lifetime incidence of CVD is about 60%, treating more patients with statins is perhaps reasonable. Furthermore, it is estimated that the new guidelines may reduce CVD by about a half million events every 10 years (2). So why are the new ACC/AHA guidelines controversial?Three of the four major identified patient groups that could benefit from statins are similar between the ACC/AHA and ATP-III guidelines. The first statin benefit group for both sets of guidelines includes individuals with known CVD. In contrast to the ATP-III guidelines, which recommend statin therapy for individuals with LDL cholesterol (LDL-C) ≥100 mg/dL (2.59 mmol/L), the ACC/AHA guidelines no longer use LDL-C as a statin treatment criterion for this patient group. In the second statin benefit group, which includes individuals with LDL-C ≥190 mg/dL (4.92 mmol/L), the recommended treatment is identical in both guidelines. For the third statin benefit group, which includes those with diabetes, the two guidelines slightly differ in their LDL-C inclusion criteria, LDL-C ≥70 …

[学科分类] 过敏症与临床免疫学