2018 (NEW) CHOLESTEROL ACC/AHA GUIDELINES Joe Sky, MD, FACC - - PowerPoint PPT Presentation

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2018 new cholesterol acc aha guidelines
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2018 (NEW) CHOLESTEROL ACC/AHA GUIDELINES Joe Sky, MD, FACC - - PowerPoint PPT Presentation

Feb 06, 2024 375 likes •722 views

2018 (NEW) CHOLESTEROL ACC/AHA GUIDELINES Joe Sky, MD, FACC Cardiologist UNDERSTANDING & IMPLEMENTING The views expressed in this presentation are Dr Skys and do not reflect an endorsement or the official policy of the the U.S.

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2018 (NEW) CHOLESTEROL ACC/AHA GUIDELINES

UNDERSTANDING & IMPLEMENTING

Joe Sky, MD, FACC Cardiologist

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The views expressed in this presentation are Dr Sky’s and do not reflect an endorsement or the official policy of the the U.S. Government, the Department of Defense, or the U.S. Air Force. Disclosures:

  • 1. Boston Heart Diagnostics, speaker.
  • 2. Blue Zones, speaker.
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Outline:

  • 1. Important changes

2. ACC/AHA slide set

  • 3. Coronary calcium history
  • 4. Lipoprotein (a), apoB & HS-crp
  • 5. Implementation ~ resources needed
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Changes

  • 1. Lifestyle is has major role – now with

monitoring

  • 2. Cholesterol targets are back
  • 3. Work towards patient goals

~ using shared decision making

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Changes

  • 4. Serial monitoring

~ Net effect of lifestyle & meds emphasized

  • 5. Team approach (pharmacy, educators, patient)
  • 6. Medications others than statins are back
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Statins

Risks

Lifestyle & Diet

2013

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We Can Do Better –

Improving the Health of the American People

Steven A. Schroeder, M.D.

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20% Medical Care 80% Ourselves

80% 20%

Our Health

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Statins & Other Medications

Risks Enhanced

Lifestyle & Diet

2018

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Lifestyle & Diet

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Lifestyle & Diet

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Lifestyle & Diet

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2018 ACC / AHA Guidelines

http://tools.acc.org/ldl/ascvd_risk_estimator/index.html#!/calulate/estimator/

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2018 ACC / AHA Guidelines See separate ACC/AHA slides

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Coronary Calcium

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CALCIUM SCORE

  • Strength of calcium scoring ~ identification of risk
  • Key tool for strict safety goals of military aviation, NASA, etc
  • Outcomes ~ entirely dependent on f/u prevention strategies
  • Calcium score should lead to more successful outcomes
  • 2018 cholesterol guidelines offer opportunity
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CALCIUM SCORE

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CALCIUM SCORE ~ DELAYS IN ACCEPTANCE

1.

Over promised with financial profiteering ~ Skepticism in scientific community ~ resentment

2.

Use by researchers and clinicians required resources / change ~ Clinical scores didn’t require testing

3.

Radiation, incidental findings, etc

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CALCIUM SCORE ~ A 2ND CHANCE? The 2018 ACC/AHA guidelines represent an opportunity

~ Use by researchers and clinicians is shifting ~ Radiation, incidental findings, etc not validated as problems ~ Inclusion in guidelines, perhaps a needed reset in thinking?

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OTHER THAN CHOLESTEROL TESTING Lipoprotein (a), apoB & HS-crp

~ National Lipid Association influence ~ Recognition that other tests help delineate risk in patients with “normal" cholesterol ~ Continued debate

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OTHER THAN CHOLESTEROL TESTING

Positive Negative

Disease

Disease

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WHEN CHOLESTEROL TESTING FAILS PATIENTS?

75% < 130mg/dL

23% <70mg/dL

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IMPLEMENTATION ~ RESOURCE NEEDS Time & Personnel changes:

Shared decision making & risk-enhancing factors discussions

  • 1. Additional testing: Calcium scoring, labs other than cholesterol
  • 2. Collaborate with the patient for therapy and follow-up

~ Additional professionals, especially clinical pharmacists

  • 3. Healthy lifestyle with relevant advice, materials, or referrals with

laboratory monitoring of meds & lifestyle.

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Examples of Patient Shared Decision Making

What You Can Do:

  • 1. Ask about your 10-year risk score if you don’t already have heart disease
  • 2. Talk about other factors that might increase your risk (called “risk enhancers”)
  • 3. If there’s any doubt, ask if CAC scoring could help

After initial visit:

  • 1. Have ongoing discussions about your risk for heart disease, heart attack or stroke keeping in mind risk

and available therapies change over time

  • 2. If you are prescribed medication(s), take it as directed, and share any concerns before stopping.
  • 3. Stick to a heart-healthy lifestyle. Enlist your family and others to help support you.
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Examples of Patient Shared Decision Making

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IMPLEMENTATION Patient resources recommended in new guidelines:

https://www.cardiosmart.org/ https://www.heart.org/en/professional/workplace-health/lifes-simple-7 https://www.lipid.org/practicetools/tools/tearsheets/practicetools/careers/ jobdescriptions https://www.lipid.org/CLMT http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/ https://statindecisionaid.mayoclinic.org

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MY PRINCIPLES FOR PREVENTIVE CARE

Customized care that reflect patient's need, values & choices ~ constructive follow-up. Screening for risks. Serial follow up testing for motivation! Medications and treatments after diet and lifestyle and patient selected interventions. Seek answers ~ evidence based approach to best medicine, diet and lifestyle

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Questions