Author + information
Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013 Nov 12 [E-pub ahead of print]; doi:10.1016/j.jacc.2013.11.002.
These corrections have been made to the print version and to the current online version of the article, which is available at http://content.onlinejacc.org/article.aspx?articleid=1770217.
1. On the cover page, the American Academy of Physician Assistants was added to the list of endorsing organizations.
2. On the cover page, the footnote now reads “This document was approved by the American College of Cardiology Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in November 2013. The Academy of Nutrition and Dietetics affirms the value of this guideline.” The footnote previously did not refer to the Academy of Nutrition and Dietetics.
3. On the cover page, Robert A. Guyton, MD, FACC has been deleted from the ACC/AHA Task Force Members.
4. General Note: Mathematical symbols changed for the following throughout the document:
a. triglycerides >500 mg/dL changed to triglycerides ≥500 mg/dL
b. ALT >3 X ULN changed to ALT ≥3 times ULN
c. non–HDL-C level >220 mg/dL changed to non–HDL-C level ≥220 mg/dL
d. high-sensitivity C-reactive protein >2 mg/L changed to high-sensitivity C-reactive protein ≥2 mg/L
5. General Note: Call-outs to the Full Panel Report Supplement were hyperlinked to the report.
6. General Note: The web-based calculator links have been updated throughout the document: http://www.cardiosource.org/en/Science-And-Quality/Practice-Guidelines-and-Quality-Standards/2013-Prevention-Guideline-Tools.aspx and http://my.americanheart.org/cvriskcalculator
7. General Note: Appendix 4. Mathematical symbols have been changed in several Evidence Statements in ways that make the text more concise but do not alter meaning.
8. Section 1.2, the last paragraph, the American Academy of Physician Assistants was added to the list of endorsing organizations.
9. Table 3. Expanded Discussion of What's New in the Guideline, moved to Appendix 5. Respective call-outs have been changed. See published document for correct placement of table.
10. Section 2, added new Table 3, “Summary of Key Recommendations for the Treatment of Blood Cholesterol to Reduce ASCVD Risk in Adults” and the following call-out sentence: “A summary of the major recommendations for the treatment of cholesterol to reduce ASCVD risk is provided in Table 3.” See published document for correct table.
11. Section 2.1, end of the paragraph, added the sentence “Drug therapy for lifestyle-related risk factors such as hypertension is often needed and smoking should be avoided.”
• In Section 2.2, second paragraph, changed from “or 4) without clinical ASCVD or diabetes with LDL–C 70 to189 mg/dL and estimated 10-year ASCVD risk >7.5%” to “and 4) primary prevention in individuals without diabetes and with estimated 10-year ASCVD risk ≥7.5%, 40 to 75 years of age who have LDL-C 70 to 189 mg/dL.”
• Also added the following text to the end of the paragraph: “Moderate evidence supports the use of statins for primary prevention in individuals with 5% to <7.5% 10-year ASCVD risk, 40 to 75 years of age with LDL-C 70 to 189 mg/dL. Selected individuals with <5% 10-year ASCVD risk, or <40 or >75 years of age may also benefit from statin therapy. Clinicians and patients should engage in a discussion of the potential for ASCVD risk reduction benefits, adverse effects, drug–drug interaction, and consider patient preferences for treatment. This discussion also provides the opportunity to re-emphasize healthy-lifestyle habits and address other risk factors.”
12. Section 2.2, the second to last paragraph, added the following: “In primary prevention, additional factors may influence ASCVD risk in those for whom a risk-based decision is unclear. These include a primary LDL-C ≥160 mg/dL or other evidence of genetic hyperlipidemias, family history of premature ASCVD with onset <55 years of age in a first-degree male relative or <65 years of age in a first-degree female relative, high-sensitivity C-reactive protein ≥2 mg/L, coronary artery calcium score ≥300 Agatston units or ≥75th percentile for age, sex, and ethnicity (for additional information, see http://www.mesa-nhlbi.org/CACReference.aspx.), ankle-brachial index <0.9, and elevated lifetime risk of ASCVD.”
13. Section 3.1, second paragraph, third bullet, “to lower LDL–C” was changed to “to reduce ASCVD risk.”
14. Table 4, Primary Prevention in Individuals ≥21 Years of Age With LDL-C ≥190 mg/dL, Recommendation #4, Class IIb level of evidence recommendation color changed from yellow to orange.
15. Section 4.5, second paragraph, added “LDL-C <70 mg/dL” to the sentence “In persons with diabetes who are <40 years of age or >75 years of age, or LDL-C <70 mg/dL, statin therapy…”
16. Section 4.6, second paragraph, LDL-C level changed from >70 mg/dL to ≥70 mg/dL in 2 instances.
17. Appendix 5, (former Table 3) multiple changes:
a. subheading ‘Focus on ASCVD Risk Reduction: 4 statin benefit groups’ under list of Four Statin Benefit Groups, #4 added: “This requires a clinician-patient discussion.”
b. subheading ‘Focus on ASCVD Risk Reduction: 4 statin benefit groups’ under letter C, Treat level of ASCVD risk header, “class III or IV heart failure” changed to “NYHA class II to IV heart failure.”
c. subheading ‘Global Risk Assessment for Primary Prevention,’ added “….prevention of ASCVD. Other factors such as LDL-C ≥160 mg/dL may also be considered. This gives…”
d. subheading “A New Perspective on LDL-C and/or Non–HDL-C Goals', second bullet, changed dose to intensity in 2 instances and in the third bullet, changed under letter B, “FH with LDL–C >190 mg/dL” to “Familial hypercholesterolemia with LDL–C ≥190 mg/dL.”
18. Figure 2 edited and clarified to more closely align with published recommendations:
a. The 3 center diamonds colored green to correspond with Class I recommendations
b. Top white box edited to read “Heart-healthy lifestyle habits are the foundation of ASCVD prevention (See 2013 AHA/ACC Lifestyle Management Guideline).”
c. Second white box on the left, changed from “>21 y” to “≥21 y.”
d. Added a green box under the 3 gray boxes on the left that says: “Regularly monitor adherence to lifestyle and drug therapy with lipid and safety assessments. See Fig 5”
e. Bottom half of figure inserted stemming from the third diamond “Diabetes”:
- Left side of figure, addition of white box that reads, “DM age <40 or >75 or LDL-C <70 mg/dL.”
- Under the diamond, addition of green Primary Prevention box with 4 boxes breaking off to indicate categories of ASCVD risk.
- Addition of the orange box regarding additional factors under the boxes indicating categories of ASCVD risk.
- Addition of the yellow Clinician-Patient Discussion box.
- Addition of the 2 blue boxes on the right indicating decision on whether to initiate statin therapy or not.
f. Footnotes have been modified according to updates in the figure.
19. Section 4.6, last paragraph, Reference 11 inserted: “For an individual <40 years of age, the 10-year horizon might not be optimal for predicting lifetime risk of ASCVD (see 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk) (11).”
20. Table 9. Nonstatin Safety Recommendations, subhead of Safety of Fibrates, footnote added to Recommendation #3, second bullet as follows: “*Consult the manufacturer's prescribing information as there are several forms of fenofibrate available.”
21. Section 10, under list of Four Statin Benefit Groups, #4 added: “This requires a clinician-patient discussion.”
22. After the references, Key Words were added: “ACC/AHA Practice Guideline ■ cardiovascular disease ■ cholesterol ■ hydroxymethylglutaryl-CoA reductase inhibitors/statins ■ primary prevention ■ secondary prevention ■ diabetes mellitus ■ drug therapy ■ risk assessment ■ risk reduction behavior ■ patient compliance ■ hypercholesterolemia ■ lipids ■ biomarkers, pharmacological.”
23. In Appendix 1, Author Relationships With Industry and Other Entities, added Susan T. Shero.
|Susan T. Shero|
|NHLBI—Public Health Advisor||2008-2012:|
24. Appendix 2. Expert Reviewers Relationships With Industry and Other Entities, added the following table note: “This table represents the relationships of reviewers with industry and other entities that were self-disclosed at the time of peer review. It does not necessarily reflect relationships with industry at the time of publication. To review the NHLBI and ACC/AHA's current comprehensive policies for managing relationships with industry and other entities, please refer to http://www.nhlbi.nih.gov/guidelines/cvd_adult/coi-rwi_policy.htm and http://www.cardiosource.org/Science-And-Quality/Practice-Guidelines-and-Quality-Standards/Relationships-With-Industry-Policy.aspx.”
• For Robert S. Rosenson, LipoScience was added to the Ownership/Partnership/Principal column.
25. Appendix 4. Evidence Statement #57, seventh bullet, “elevated” added to the beginning of statement, “Elevated levels of uric acid, serum glutamic oxaloacetic transaminase, alkaline phosphatase, and glucose.”
- The Expert Panel Members