Table. Key Similarities and Differences Among Major Cholesterol Guidelines.
| ACC/AHA (2013) | ADA (2015) | NICE (2014) | NLA (2014) | |
|---|---|---|---|---|
| Risk assessment | ||||
| Screening | Fasting lipids | Fasting lipids | Fasting/nonfasting lipids | Fasting/nonfasting lipids |
| Eligibility for primary prevention if LDL-C <190 mg/dL |
Age 40-75 y and LDL-C 70-189 mg/dL |
Age >40 y (see exceptions) | Age 40-84 y (exception: type 1 diabetes) |
Age ≥20 y and categorization (low, moderate, high, and very high risk) |
| 10-y risk calculator for primary prevention |
PRC | Not recommended | QRISK2 2014 risk calculator (except for type 1 diabetes) |
If 2 major risk factors, FRS or PRC |
| 10-y risk threshold for primary prevention |
≥7.5% | None | ≥10.0% | ≥10.0% (FRS) ≥15% (PRC) |
| Lipid targets (with lifestyle therapy) |
||||
| ASCVD, FH, or LDL-C ≥190 mg/dL |
High-dose statin; >50% reduction in LDL-C |
High-dose statin; >50% reduction in LDL-C |
High-dose statin | Non-HDL-C <100 mg/dL; LDL-C <70 mg/dL |
| Preferred treatment | Atorvastatin, 40-80 mg, or rosuvastatin, 20-40 mg |
Atorvastatin, 80 mg | High-dose statin plus nonstatin treatment to achieve goal |
|
| Primary prevention if no FH and LDL-C <190 mg/dL |
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| Diabetes not present | Moderate-dose statin to lower LDL-C >30%-50% |
Non-HDL-C reduction >40% (atorvastatin, 20 mg/d) |
Non-HDL-C <130 mg/dLand LDL-C <100 mg/dL for low, moderate, or high risk |
|
| Diabetes present | Type 2 or type 1: moderate-dose statin if risk <7.5%; high-dose statin if risk ≥7.5% |
If age 40-75 y, moderate-dose statin for 30%-50% reduction in LDL-C if no other risk factors; high-dose statin if additional risk factors If age <40 y and other risk factors, moderate- to high-dose statin |
Type 2: same as above Type 1: same as above if age >40 y, duration >10 y, chronic kidney disease, or other risk factors |
Type 2 or 1: non-HDL-C<100 mg/dL and LDL-C <70 mg/dL if ≥2 risk factors or end organ damage |
| Older adults | Not indicated if age >75 y | Same as above for age >40 y | If age <85 y, statin per QRISK2 assessment If age ≥85 y, consider statin but individualize |
Not stated; follow risk categories as defined |
| Adherence to therapy | Initially at 4-12 wk, then every 3-12 mo (no goals for LDL-C or non-HDL-C) |
Monitor as needed (no goals for LDL-C or non-HDL-C) |
At 3 mo to assess non-HDL-C, then yearly |
Every 4-12 mo to follow goals |
Abbreviations: ACC, American College of Cardiology; ADA, American Diabetes Association; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; FH, familial hypercholesterolemia; FRS, Framingham risk score; non–HDL-C, non–high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; NICE, National Institute for Health and Care Excellence; NLA, National Lipid Association; PRC, pooled risk calculator.