Cholesterol Management Update
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Several approaches to cholesterol management have traditionally been used, including "treat-to-target" and "lower is better." In 2001, the National Cholesterol Education Program (NCEP) issued a guideline on cholesterol management that was most recently updated in 2004. The guideline set specific LDL targets for treatment in different risk groups. In November of 2013, the American College of Cardiology and the American Heart Association (ACC/AHA) published an updated cholesterol guideline to help providers reduce the overall risk for atherosclerotic cardiovascular disease (ASCVD). As in the previous guideline, lifestyle measures such as a heart-healthy diet, regular exercise, avoiding tobacco products, and maintaining a healthy weight remain the foundation for risk reduction (see the Patient Connection). However, the 2013 recommendations for drug treatment (specifically, statin use) represent a paradigm shift. The 2013 guideline features the elimination of LDL and non-HDL treatment targets; the identification of 4 statin benefit groups with corresponding recommendations for the intensity of statin treatment; the introduction of a new cardiovascular (CV) risk assessment calculator, to estimate 10-year ASCVD risk; and safety recommendations, including management of statin side effects. The new guideline has been the subject of intense controversy.
This issue of The Rx Consultant presents the guideline’s background, its key recommendations for treatment and for safety monitoring, and a discussion of the controversy it caused. You'll also find additional statin information (updated since our 2006 issue) including key differences among agents.
Publication Date: 02/18/2014
Expiration Date: 02/18/2017
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based
This program was developed by The Rx Consultant and published by Continuing Education Network, Inc.
The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and
is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased,
balanced information to health care practitioners.
Programs developed by The Rx Consultant are written by health care providers with expertise in the topic
area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure
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providers, and written in an easy reading, "plain English" style.
Michelle M. Lamb, Jessica M. Downes, Kelsey T. Lackey
Dr. Lamb, Dr. Downes, and Dr. Lackey report no financial or personal relationship with any commercial interest
producing, marketing, reselling, or distributing a product or service that appears in this issue.
This accredited program is targeted to pharmacists and nurses.
Goals & Objectives
At the conclusion of this program, participants will be able to:
- Outline the main differences between the 2013 ACC /AHA cholesterol management guideline and the previous NCEP guideline. Discuss the controversy about the new guideline.
- Describe the 4 statin benefit groups identified in the 2013 guideline, and the recommended intensity of statin therapy for each. List at least 2 regimens of each intensity.
- Discuss monitoring for statin response and adverse effects. Provide 1-2 patient counseling tips about myopathy, liver dysfunction, cognitive impairment and new-onset diabetes.
- List at least 3 drug interactions that may affect statin levels and/or increase the risk of myopathy.
The Rx Consultant is a publication of Continuing Education Network, Inc.
Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a
provider of continuing pharmacy education.
Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.
ACPE Universal Activity Number: 0428-0000-14-004-H01-P
Exam & Credit Statement Procedures
Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and
Editorial and Review Board
Chief Editor and CE Administrator
Terry M. Baker, PharmD
Tracy Farnen, PharmD
James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA
Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA
Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA
Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System
Adjunct Clinical Professor
College of Pharmacy
Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Visiting Associate Professor and Lecturer
Samuel Merritt University
Pamela Mausner, MD
Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Senior Editorial Advisor
Gerard Hatheway, PharmD, PhD
Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD
Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners
Meuleman, RN, C, MS
About the Rx Consultant
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