Quiz: The 2017 AACE/ACE Lipid Management and CVD Prevention Guidelines

1. The 2017 AACE/ACE guidelines for management of dyslipidemia in T2D identify three additional conditions as  major independent risk factors for ASCVD. Which of the following is not included? 

A. Polycystic ovarian syndrome

B. Age (women ≥ 60, men ≥ 65 years)

C. Chronic kidney disease (CKD) stages 3-4

D. Coronary artery calcification

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The correct answer is B. Age (women  ≥ 60, men ≥ 65 years)

The updated 2017 AACE/ACE clinical practice guidelines list 3 additional conditions as major independent risk factors for ASCVD: polycystic ovarian syndrome, CKD stage 3-4, and signs of coronary artery calcification. These are in addition to the classic risk factors: smoking, hypertension (BP ≥ 140/90 mmHg or use of antihypertensives), low LDL (< 40 mg/dL), family history of early CAD (first degree relative <65 years for women; first degree relative <55 years for men), and age.  Age cutoffs are ≥55 years in women, and ≥45 years in men.

2. The 2017 AACE/ACE lipid guidelines were broadened to include a new “extreme” ASCVD risk  category, to include patients with T2D plus which of the following:

A. Past ASCVD event

B. Smoking

C. CKD stage 3-4

D. Both A and C

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The correct answer is D. Both A. Past ASCVD event and C. CKD stage 3-4

The 2017 updated AACE/ACE guidelines introduced a new extreme risk category for secondary or recurrent prevention of ASCVD events.  This category applies to patients with T2D who have had a past ASCVD event (recognized as “clinical ASCVD”) or CKD stage 3 or 4.  Smoking is one of the classic risk factors for ASCVD events for all individuals. It is not listed as one of the factors for classifying patients according to the new extreme risk category.

3. What is the goal for LDL-C in individuals with T2D who are in the extreme ASCVD risk category?

A. < 50 mg/dL

B. < 55 mg/dL

C. < 60 mg/dL

D. < 65 mg/dL

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The correct answer is B. < 55 mg/dL

The 2017 updated AACE/ACE guidelines call for an LDL goal of < 55 mg/dL in patients with T2D who are classified at extreme risk for ASCVD events, the first time a professional organization has set forth a recommended reduction this low. The non-HDL-C goal is < 80 mg/dL, and the ApoB goal is < 70 mg/dL.1

4. The 2017 AACE/ACE guidelines recommend specific goals for LDL particle (LDL-P) in the management of patients with T2D and hyperlipidemia.

A. True

B. False

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The correct answer is B. False

The 2017 guidelines do not specifically recommend the use of LDL-P goals in the management of patients with T2D and hyperlipidemia, other than to say that LDL-P goals may be useful in lipid management.  No consensus exists surrounding target goals, due to lack of evidence. However, the guidelines do list suggested targets:

   ^♦ High risk: < 1200 nmol/L

   ^♦ Very high risk: < 1000 nmol/L

   ^♦ Extreme risk: None proposed

5. What is the LDL-C lowering efficacy of statins?

A. 15 to > 30%

B. 20 to > 35%

C. 25 to > 40%

D. 30 to > 50%

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The correct answer is D. 30 to > 50%

According to the 2017 AACE/ACE guidelines, the LDL-C lowering efficacy of statins is 30 to > 50%. Other drugs like exetimibe, bile acid sequestrants, fibrates, and niacin have less LDL-C lowering efficacy, ranging from 7 to 20%. However, the latter can still significantly lower LDL when used in combination therapy, especially for statin-intolerant patients or individuals who have reached their maximum tolerated statin dose and require add-on therapy.

Source

Jellinger PS, Handelsman Y, Rosenblit PD, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease – Executive Summary. Endocr Pract. 2017 Apr 2;23(4):479-497. doi: 10.4158/EP171764.GL. Epub 2017 Feb 3.