AHA: New Guidelines for Cholesterol Management

The American Heart Association (AHA) and American College of Cardiology (ACC), as well as 10 other organizations, have updated the guidelines on how to best manage blood cholesterol.1


The guidelines were presented at the AHA’s Scientific Sessions 2018 and published in Circulation on November 20, 2018.


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High cholesterol treatment is not one size fits all, and this guideline strongly establishes the importance of personalized care,” said Michael Valentine, MD, FACC, ACC president. “Over the past 5 years, we’ve learned even more about new treatment options and which patients may benefit from them. By providing a treatment roadmap for clinicians, we are giving them the tools to help their patients understand and manage their risk and live longer, healthier lives.”2


The first point the guidelines make is that health care providers should emphasize a heart-healthy lifestyle for all ages in order to reduce the risk of atherosclerotic cardiovascular disease (ASCVD).


The groups say that reducing cardiovascular disease risk should start at an early age, with children as young as 2 years of age who have a family history of heart disease or high cholesterol and are able to undergo selective cholesterol testing.


The guidelines also recommend more detailed risk assessments that can help better determine each patient’s risk and treatment options.


For example, the guidelines recommend that a coronary artery calcium measurement be taken for patients whose risk level is not clear and whose treatment decisions are less certain in order to determine their need for cholesterol-lowering treatment.


Recommended approaches to statin therapy for different groups are also included in the updated guidelines.


For instance, for patients who have already had a myocardial infarction or stroke and are at the highest risk for another and whose low-density lipoprotein cholesterol levels are not adequately lowered by statin therapy, it is recommended to prescribe other cholesterol-lowing drugs, such as a stepped-approach of ezetimibe, that can be added to a statin regimen. A PCSK9 inhibitor could be added if patients do not respond well enough to the combination treatment.


The updated guideline includes 10 recommendations in all. For the full list, click here.


—Colleen Murphy



  1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines [published online November 10, 2018]. Circulation. doi:10.1161/CIR.0000000000000625.
  2. Updated cholesterol guidelines offer more personalized risk assessment, additional treatment options for people at the highest risk [press release]. Chicago, IL: American Heart Association; November 10, 2018. Accessed November 13, 2018.