2018 Updated AHA/ACC Multisociety Cholesterol Guideline: 5 Things to Know

Neil J. Stone, MD, FACC; Scott M. Grundy MD, PhD


November 01, 2019

Editorial Collaboration

Medscape &

The 2013 American Heart Association/American College of Cardiology (AHA/ACC) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Disease in Adults[1] shifted the paradigm from a treat-to-target low-density lipoprotein cholesterol (LDL-C) approach to an evidence-based one focusing on at-risk groups. Nonstatin drugs were not recommended owing to the lack of large-scale randomized controlled trial (RCT) data supporting the benefits of their use.

The updated 2018 AHA/ACC Multisociety Cholesterol Guideline[2] further refined the secondary prevention category and expanded the scope of primary prevention to include all age groups.

Here are five things to know about the 2018 AHA/ACC guideline.

1. Lifestyle modifications across the life course are fundamental.

The update expanded lifestyle recommendations to include the pediatric population (aged 0-18 years). Lifestyle intervention includes dietary modifications, weight control, regular physical activity, and no tobacco use. The guideline endorsed lifestyle as the foundation for preventing or controlling atherosclerotic cardiovascular disease (ASCVD) risk factors over the life course (Figures 1 and 2). In particular, maintaining optimal risk-factor levels in middle age is associated with substantially longer morbidity-free survival.[3]

Download the PDF version of Figure 1

Download the PDF version of Figure 2


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