Key updates (in bold) to the cholesterol guidelines
| Topic | 2013 | 2018 |
|---|---|---|
| Lifestyle | Cornerstone of ASCVD and prevention | Cornerstone of ASCVD and prevention |
| First-line drugs for ASCVD risk reduction | Statins | Statins |
| Clinician-patient risk discussion | Introduced | Emphasized before beginning statin |
| Risk assessment in primary prevention | Starts with PCE risk estimation | Starts with PCE risk estimation |
| Tailoring treatment | Some biomarkers and noninvasive tests | Extensive list of risk enhancers |
| Intermediate risk patients | No recommendation for additional testing | Consider CAC scoring and risk enhancers |
| Nonstatin agents in secondary prevention | None | Ezetimib (Zetia) PCSK9 inhibitors |
ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium; PCE = Pooled Cohort Equation; PCSK9 = proprotein convertase subtilisin-kexin type 9
Source: Data from references 3 and 4.