AACE/ACE Lipid Guidelines Define Extreme CVD Risk

The lipid management guidelines issued by the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) in April 2017 take a step back in time and re-affirm the use of LDL-C targets to help minimize cardiovascular risk in all patients, and especially those with T2DM. The shift away from the 2013 recommendations by cardiology societies, which focus on primary and secondary treatment categories and medications, includes a first-ever "extreme risk" patient category for whom an LDL-C level of < 55 mg/dL is advised. More discussion around targets vs no targets is ensured.

In this short slide show, we summarize the "extreme risk" category and treatment targets as well as other updates to the 2017 AACE/ACE statement.

AACE/ACE 2017 T2DM guideline emphasizes early intensive management of dyslipidemia to decrease significant risk of ASCVD in T2D and highlights new algorithm for controlling dyslipidemia to decrease ASCVD risk in T2D.

AACE/ACE 2017 T2DM guideline defines new major independent risk factors for ASCVD in patients with T2DM: Polycystic ovary syndrome, CKD stage 3-4, signs of coronary artery calcification.

AACE/ACE 2017 T2DM guideline sets cutoffs for very high risk (T2D + ≥ 1 risk factor) and high risk (T2D, no other risk factors and/or age < 40y) for LDL-C, non-HDL-C, triglycerides, and apo B.

AACE/ACE 2017 T2DM guideline establishes new “extreme” ASCVD risk category: T2D plus prior ASCVD event (“clinical” ASCVD) or CKD stage 3-4; first organization to include recommendation for LDL-C reduction to < 55 mg/dL. 

AACE/ACE 2017 T2DM guideline notes lipid particle management may be useful but that there is no evidence to establish target goals.

AACE/ACE 2017 T2DM guideline recommends statin drugs as first-line therapy with intensification and adjunct medications added as requird to reach targeted therapeutic levels.