2013 American College of Cardiology/American Heart Association Lipid Guidelines after the 2016 American College of Cardiology Expert Panel Consensus Statement: To err is human, to admit it, divine

V. G. Athyros, G. Sfikas, C. Boutari, K. Imprialos, K. Tziomalos, A. Karagiannis



The 2016 American College of Cardiology (ACC) Expert Panel Consensus Statement addresses the current gaps in low-density lipoprotein cholesterol (LDL-C) lowering strategies to reduce cardiovascular risk. The goal was to provide practical guidance for clinicians and patients in cases not covered by the 2013 ACC/American Heart Association lipid guidelines until the next round of guidelines has the opportunity to formally review recent scientific evidence and cardiovascular outcomes trials are completed with new agents for cardiovascular risk reduction. The new aspects in comparison to the 2013 guidelines are mainly two. The Writing Committee suggests specific LDL-C targets (which were absent in the 2013 ACC/AHA guidelines) rather than LDL-C percent reductions so that we have a benchmark to use statin with non-statin drug combinations, and it encourages the use of ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors if statin monotherapy is not enough for the attainment of these specific LDL-C targets or in cases of statin intolerance. The Consensus acts in several issues as a bridge between the 2013 guidelines to the next ACC/AHA guidelines as well as to European Society of Cardiology/European Atherosclerosis Society guidelines. Our opinion is that there is still way to go, because we live in an obese world with a pandemic of diabetes mellitus and the related mixed (combined) dyslipidaemia, responsible for the residual cardiovascular risk after statin treatment, this issue has not been addressed at all by the Consensus, which remains LDL-C-oriented.

Keywords: 2016 ACC Consensus Statement, 2013 ACC/AHA Guidelines, statins, non-statin treatment