The American Heart Association’s 2018 Scientific Sessions, held in Chicago on Nov. 10-12, were all about the blood lipids. In poster sessions and presentations, as well as a major guideline update, this year’s gathering highlighted the progress we’ve made in lipid management. Some of the major announcements included:
New Cholesterol Clinical Practice Guidelines.
New cholesterol-management guidelines were introduced by the American Heart Association and American College of Cardiology. The guidelines don’t represent a major overhaul of the 2013 recommendations, and their major features will look familiar, including the use of the 10-year risk calculator to guide medication management. The guidelines also avoided giving a specific target number for LDL cholesterol while instead focusing on lifestyle modification and prevention (although the AHA does note that an optimal cholesterol level is about 150 mg/dL, with LDL at or below 100 mg/dL).
While some things did stay the same, new elements include:
- New risk factors. The new guidelines still rely on traditional risk factors (smoking status, high blood pressure, and elevated blood glucose), but also add additional “risk-enhancing factors” including family history and ethnicity, metabolic syndrome, chronic kidney disease, and others in the decision-making process. Clinicians are also encouraged to use the coronary artery calcium score as a secondary-line tool.
- Non-fasting lipid testing gets the green light. Until now, fasting lipid testing was recommended, which was inconvenient for patients who needed to fast, then get their blood drawn at a clinic, and wait for results. Now clinicians can use non-fasting lipid results in their assessments.
- New treatment options for patients at very high risk. For patients who are at very high risk and unable to achieve an LDL score of 70 mg/dL, non-statin therapies such as ezetimibe and PCSK9 inhibitors are recommended.
The full guidelines are available in the journal Circulation.
VITAL trial: Omega-3s protect the heart; vitamin D benefits cancer mortality.
Results from the Vitamin D and OmegA-3 Trial were featured in a Late-Breaking Clinical Trial session. This study is the only large, well-designed study of its kind to look at fish oil supplements in a healthy population, and one of only two randomized clinical trials examining vitamin D’s role in the primary prevention of cancer, heart disease, and stroke. According to one of the study’s authors, JoAnn Manson, MD, DrPH, omega-3 fatty acids were shown to protect healthy people against heart disease, while vitamin D reduces cancer mortality. The study enrolled almost 26,000 U.S. adults with no history of heart disease, cancer, or stroke. During the study period, subjects took 2,000 IU daily of vitamin D3 or 1 gram daily of marine-derived omega-3 fatty acids. Over the 5-year study period, consumption of 1 gram of fish oil daily was associated with a 28% reduction in total heart attacks, as well as significant reductions in fatal heart attacks, percutaneous coronary interventions, and total coronary heart disease. According to Manson, after adjusting for study variables, this is a greater or comparable risk reduction than seen with the use of daily aspirin or statin therapy. The benefits were especially pronounced among African-Americans and among people who ate less than 1 serving of fish weekly.
The Wellness Network is proud to partner with the American Heart Association to offer you comprehensive patient education on cholesterol management and heart attack risk reduction. Our library of patient-education videos and print material is fully updated and compliant with the 2018 cholesterol guidelines, so you can be confident your patients are receiving the most current, clinically validated education.
-  American College of Cardiology. New ACC/AHA Cholesterol Guideline Allows for More Personalized Care; New Treatment Options. https://www.acc.org/latest-in-cardiology/articles/2018/11/07/15/19/sat-1130am-guideline-on-the-management-of-blood-cholesterol.