Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) guidelines for management of dyslipidemia and cardiovascular disease risk reduction: Putting evidence in context

Mahmoud Al Rifai, Roger S. Blumenthal, Neil J. Stone, Richard S. Schofield, Carl Edward Orringer, Erin D. Michos, Paul A. Heidenreich, Lynne Braun, Kim K. Birtcher, Sidney C. Smith, Vijay Nambi, Scott Grundy, Salim S. Virani*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in the United States (U.S.) and incurs significant cost to the healthcare system. Management of cholesterol remains central for ASCVD prevention and has been the focus of multiple national guidelines. In this review, we compare the American Heart Association (AHA)/American College of Cardiology (ACC) and the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) Cholesterol guidelines. We review the evidence base that was used to generate recommendations focusing on 4 distinct themes: 1) the threshold of absolute 10-year ASCVD risk to start a clinician-patient discussion for the initiation of statin therapy in primary prevention patients; 2) the utility of coronary artery calcium score to guide clinician-patient risk discussion pertaining to the initiation of statin therapy for primary ASCVD prevention; 3) the use of moderate versus high-intensity statin therapy in patients with established ASCVD; and 4) the utility of ordering lipid panels after initiation or intensification of lipid lowering therapy to document efficacy and monitor adherence to lipid lowering therapy. We discuss why the VA/DoD and AHA/ACC may have reached different conclusions on these key issues.

Original languageEnglish (US)
Pages (from-to)2-6
Number of pages5
JournalProgress in Cardiovascular Diseases
Volume68
DOIs
StatePublished - Sep 1 2021

Keywords

  • Atherosclerotic cardiovascular disease
  • Cholesterol
  • Guidelines
  • Prevention
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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