The New 2018 Cholesterol Guidelines: Filling Gaps and Expanding Opportunities

Amit Khera, MD, MSc


Circulation. 2019;139(25):2805-2808. 

In This Article

Abstract and Introduction


The long-anticipated release of the 2018 American College of Cardiology/American Heart Association cholesterol guidelines is now at hand and likely to be met with broad interest by clinicians in multiple specialties.[1]

The last update to the American College of Cardiology/American Heart Association cholesterol guidelines in 2013 takes a much narrower approach to evidence assessment than prior guidelines, focusing predominantly on evidence from high-quality randomized clinical trials.[2] This resulted in the elimination of low-density lipoprotein cholesterol (LDL-C) treatment goals from the document, which had been a mainstay in prior guidelines and clinical practice. The writing group created a simplified algorithm of 4 groups who were most likely to benefit from moderate- or high-intensity statin therapy (Table). This approach greatly expanded the number of individuals eligible for statins in the population. In addition to eliminating LDL-C treatment goals, the old guideline recommended minimal use of nonstatin therapies. However, there was no clinical trial evidence to support a strategy of targeting specific LDL-C numbers, and at that time, there were sparse data supporting the addition of nonstatin therapies to statins to further lower atherosclerotic cardiovascular disease (ASCVD) events.