Guidelines for the Digital Age

An Interview With ACC President John Harold, MD

John G. Harold, MD; Tricia Ward


November 20, 2013

In This Article

Editor’s Note: Medscape interviewed John Harold, MD, President of the American College of Cardiology (ACC), about the publication of 4 long-awaited guidelines on cardiovascular disease[1,2,3,4], including the practice-changing cholesterol guidelines, and how to make guidelines more user-friendly in the digital age.

New Cholesterol Guidelines: A Paradigm Shift

John Harold, MD

Medscape: Do you anticipate confusion among clinicians with the change in focus in the new cholesterol guidelines?

Dr. Harold: We have moved the focus from LDL-C targets to cardiovascular risk and treating patients who will have the greatest benefit. It's a paradigm shift, but it's not all that different from the paradigm shift that occurred in antibiotic prophylaxis for endocarditis several years ago. Physicians across the country saw the rationale and the evidence base for that and changed practice fairly rapidly. There is an education component to this, but ultimately it will improve the quality of care delivered and identify those patients who are most likely to benefit from strategies that are associated with proven risk reduction. At the end of the day, we'll be targeting patients who are high-risk but are not getting appropriate evidence-based care at the moment. That said, I think there will be a learning curve to this.

Medscape: In terms of that learning curve, how will the ACC support clinicians with this?

Dr. Harold: The guidelines are the result of a collaborative effort between the American Heart Association (AHA), the ACC, the National Heart, Lung, and Blood Institute (NHLBI), and other organizations. Several organizations were involved in reviewing the document, but the document, for the most part, reflects the work product of the writing group and it reflects the evidentiary review that was performed under the auspices of the NHLBI.

The education will be a collaborative effort of all of these organizations, and there will be discussions at the AHA meeting in Dallas, and in the relevant journals such as Circulation, Journal of American College of Cardiology, the obesity journals, and so on.

The focus of the cholesterol guidelines is that tailored treatment is simpler, safer, and more effective, and it's based on the available evidence.

The efficacy of treating LDL-C targets has never been proven clinically. Indeed, there's no scientific basis in the literature to support treating to specific targets, and the committee could not find a particular threshold that they could support as opposed to a more tailored approach that focuses on a patient's individual risk, their lifestyle, and the multiple interventions that can be done. That is the philosophy going forward.


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