Critical review of 2016 ACC guidelines on therapies for cholesterol lowering with reference to laboratory testing

Abstract

Introduction: This review discusses new guidelines that were released in 2016 and 2017 for assessing risk of coronary disease (ASCVD) and treatments and that appear to have replaced the 2013 guidelines which superseded the National Cholesterol Education Program Adult Treatment Panel Guidelines (ATP). To put the new guidelines in prospective, I briefly review the history of prior guidelines. The newest guidelines seem to support the idea that elevated LDL cholesterol (C) is a cause of ASCVD. The Review also discusses issues related to these guidelines, especially measurement of LDLC, the importance of nonHDLC and puzzling results that do not seem to support the cause and effect idea.

Methods: Literature review and critical discussion.

Conclusions: The 2016 guidelines appear to eliminate most of the flaws in the prior 2013 guidelines that replaced the ATP. They do not seem to rely on randomized control studies alone but the totality of all of the evidence. The new guidelines still fail to identify some persons with characteristics of metabolic syndrome that may be of increased risk for ASCVD although they address some of the problems in treating this group. The guidelines identify LDL cholesterol and nonHDL cholesterol target concentrations that are important for laboratory professionals since they should be defined on reports and are important for consultation.

Keywords: Cholesterol; Cholesterol target concentrations; Coronary risk; Measurement of cholesterol; Treatment guidelines; nonHDL cholesterol.