Merits and potential downsides of the 2013 ACC/AHA cholesterol management guidelines

Nutr Metab Cardiovasc Dis. 2014 Jun;24(6):573-6. doi: 10.1016/j.numecd.2014.04.002. Epub 2014 Apr 18.


New guidelines from the American College of Cardiology and the American Heart Association on cholesterol management introduced substantial changes from the previous Adult Treatment Panel III guidelines and generated an immediate storm of controversy upon their release in November 2013. Four categories of individuals that can benefit from statin therapy, including three high-risk groups, have been identified. The fourth category of primary prevention has proven to be the most contentious, with criticism centering on the algorithm used to estimate ten-year risk for atherosclerotic cardiovascular disease and the optimal threshold for statin therapy. Although the risk assessment algorithm can be further refined, it represents an improvement from the previous calculator since it better captures risk in women and African Americans. However, the elimination of lipid targets in the new guidelines discounts a wealth of clinical trial and epidemiological evidence indicating that, with regards to low-density lipoprotein cholesterol, "lower is better." Recommendations regarding the use of nonstatin drugs, while appropriate, could potentially be revised in the future. In general, the new guidelines stress the necessity of addressing the multiple factors that contribute to cardiovascular risk, and they provide a valuable opportunity for physicians to address the importance of lifestyle modifications to lower a patient's overall risk.

Keywords: Cholesterol; Dyslipidemia; Guidelines.

MeSH terms

  • Aged
  • American Heart Association
  • Atherosclerosis / epidemiology
  • Atherosclerosis / etiology
  • Atherosclerosis / prevention & control
  • Biomarkers / blood
  • Cardiology / trends
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Cholesterol, LDL / blood
  • Combined Modality Therapy / adverse effects
  • Diabetes Complications / blood
  • Diabetes Complications / physiopathology
  • Diabetes Complications / prevention & control
  • Diabetes Complications / therapy
  • Evidence-Based Medicine*
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypercholesterolemia / complications
  • Hypercholesterolemia / physiopathology
  • Hypercholesterolemia / prevention & control
  • Hypercholesterolemia / therapy*
  • Life Style
  • Middle Aged
  • Practice Guidelines as Topic*
  • Precision Medicine*
  • Risk Assessment
  • Risk Factors
  • Societies, Medical
  • United States / epidemiology


  • Biomarkers
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors