{"markup":"\u003C?xml version=\u00221.0\u0022 encoding=\u0022UTF-8\u0022 ?\u003E\n    \u003Chtml version=\u0022HTML+RDFa+MathML 1.1\u0022\n    xmlns:content=\u0022http:\/\/purl.org\/rss\/1.0\/modules\/content\/\u0022\n    xmlns:dc=\u0022http:\/\/purl.org\/dc\/terms\/\u0022\n    xmlns:foaf=\u0022http:\/\/xmlns.com\/foaf\/0.1\/\u0022\n    xmlns:og=\u0022http:\/\/ogp.me\/ns#\u0022\n    xmlns:rdfs=\u0022http:\/\/www.w3.org\/2000\/01\/rdf-schema#\u0022\n    xmlns:sioc=\u0022http:\/\/rdfs.org\/sioc\/ns#\u0022\n    xmlns:sioct=\u0022http:\/\/rdfs.org\/sioc\/types#\u0022\n    xmlns:skos=\u0022http:\/\/www.w3.org\/2004\/02\/skos\/core#\u0022\n    xmlns:xsd=\u0022http:\/\/www.w3.org\/2001\/XMLSchema#\u0022\n    xmlns:mml=\u0022http:\/\/www.w3.org\/1998\/Math\/MathML\u0022\u003E\n  \u003Chead\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_itu2PgFdrjV-docKmLK8Jn5oXe_05RgvQh73eOhI_mE.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/js\/js_I8yX6RYPZb7AtMcDUA3QKDZqVkvEn35ED11_1i7vVpc.js\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\n(function(i,s,o,g,r,a,m){i[\u0022GoogleAnalyticsObject\u0022]=r;i[r]=i[r]||function(){(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)})(window,document,\u0022script\u0022,\u0022\/\/www.google-analytics.com\/analytics.js\u0022,\u0022ga\u0022);ga(\u0022create\u0022, \u0022UA-15605596-27\u0022, {\u0022cookieDomain\u0022:\u0022auto\u0022});ga(\u0022set\u0022, \u0022page\u0022, location.pathname + location.search + location.hash);ga(\u0022send\u0022, \u0022pageview\u0022);ga(\u0027create\u0027, \u0027UA-189672-26\u0027, \u0027auto\u0027, {\u0027name\u0027: \u0027hwTracker\u0027});\r\nga(\u0027hwTracker.send\u0027, \u0027pageview\u0027);\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022\u003E\n\u003C!--\/\/--\u003E\u003C![CDATA[\/\/\u003E\u003C!--\njQuery.extend(Drupal.settings, {\u0022basePath\u0022:\u0022\\\/\u0022,\u0022pathPrefix\u0022:\u0022\u0022,\u0022highwire\u0022:{\u0022markup\u0022:[{\u0022requested\u0022:\u0022full-text\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/19\\\/7\u0022},{\u0022requested\u0022:\u0022long\u0022,\u0022variant\u0022:\u0022full-text\u0022,\u0022view\u0022:\u0022full\u0022,\u0022pisa\u0022:\u0022spmdc;14\\\/19\\\/7\u0022}],\u0022ac\u0022:{\u0022spmdc;14\\\/19\\\/7\u0022:{\u0022access\u0022:{\u0022reprint\u0022:true,\u0022full\u0022:true},\u0022pisa_id\u0022:\u0022spmdc;14\\\/19\\\/7\u0022,\u0022atom_uri\u0022:\u0022\u0022,\u0022jcode\u0022:\u0022spmdc\u0022}}},\u0022googleanalytics\u0022:{\u0022trackOutbound\u0022:1,\u0022trackMailto\u0022:1,\u0022trackDownload\u0022:1,\u0022trackDownloadExtensions\u0022:\u00227z|aac|arc|arj|asf|asx|avi|bin|csv|doc(x|m)?|dot(x|m)?|exe|flv|gif|gz|gzip|hqx|jar|jpe?g|js|mp(2|3|4|e?g)|mov(ie)?|msi|msp|pdf|phps|png|ppt(x|m)?|pot(x|m)?|pps(x|m)?|ppam|sld(x|m)?|thmx|qtm?|ra(m|r)?|sea|sit|tar|tgz|torrent|txt|wav|wma|wmv|wpd|xls(x|m|b)?|xlt(x|m)|xlam|xml|z|zip\u0022,\u0022trackUrlFragments\u0022:1},\u0022ajaxPageState\u0022:{\u0022js\u0022:{\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/jquery.cluetip.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.hoverIntent.js\u0022:1,\u0022sites\\\/all\\\/libraries\\\/cluetip\\\/lib\\\/jquery.bgiframe.min.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_at_symbol.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/highwire\\\/highwire\\\/plugins\\\/highwire_markup_process\\\/js\\\/highwire_article_reference_popup.js\u0022:1,\u0022sites\\\/all\\\/modules\\\/contrib\\\/google_analytics\\\/googleanalytics.js\u0022:1,\u00220\u0022:1}}});\n\/\/--\u003E\u003C!]]\u003E\n\u003C\/script\u003E\n\u003Clink type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe appropriateness of the new American College of Cardiology\/American Heart Association (ACC\/AHA) \u201cGuideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults\u201d for patients with diabetes was reviewed in this article [Stone NJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2014; \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2014].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELipid Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EEndocrinology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Metabolic Syndrome\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe appropriateness of the new American College of Cardiology\/American Heart Association (ACC\/AHA) \u201cGuideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults\u201d for patients with diabetes was reviewed in this session [Stone NJ et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2014; \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EArguing in favor of the use of the ACC\/AHA guideline to make treatment decisions for patients with diabetes was Robert H. Eckel, MD, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. The new guideline reflects the knowledge that vigilant diabetes care has been beneficial, he said, with diabetes-related complications declining from 1995 to 2010, including acute myocardial infarction, stroke, and limb amputation [Gregg EW et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2014].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003ESimilarities between the 2013 ACC\/AHA guideline and the one that it replaces (National Cholesterol Education Program Adult Treatment Panel III [ATP III]) are the emphasis on lifestyle, the focus on low-density lipoprotein cholesterol (LDL-C) and the patients at highest risk, and the preference for statins for lipid-lowering therapy.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe greater emphasis on statin use in the 2013 ACC\/AHA guideline compared with ATP III is appropriate, stated Dr. Eckel. Statin therapy clearly produces benefits in patients diagnosed with clinical atherosclerotic cardiovascular disease (ASCVD) and those \u2265 \u2265 21 years of age with LDL-C \u2265 190 mg\/dL (\u0026gt; 4.91 mmol\/L). Furthermore, statins are a primary therapy for patients with and without diabetes who are at risk of ASCVD, and they are recommended for 4 benefit groups (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14611\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14611\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14611\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EFour Statin Benefit Groups in the 2013 ACC\/AHA Guideline for Blood Cholesterol\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EA meta-analysis of 26 randomized controlled trials (RCTs) involving some 170,000 patients showed a reduction of 22% in major vascular events per 1.0-mmol\/L reduction in LDL-C from baseline (rate ratio [RR], 0.78; 95% CI, 0.76 to 0.80; p\u0026lt; .0001) [Cholesterol Treatment Trialists\u0027 Collaboration. \u003Cem\u003ELancet\u003C\/em\u003E 2010]. Another meta-analysis by these investigators of 18,686 patients with type 2 diabetes mellitus (T2DM) showed that for each 1-mmol\/L reduction in LDL-C, there were similar reductions in major vascular events (RR, 0.79; 95% CI, 0.72 to 0.86; p\u0026lt; .0001), stroke (RR, 0.79; 95% CI, 0.67 to 0.93; p = .0002), coronary revascularization (RR, 0.75; 95% CI, 0.64 to 0.88; p\u0026lt; .0001), and all-cause mortality (RR, 0.91; 95% CI, 0.82 to 1.01; p = .02) [Cholesterol Treatment Trialists\u0027 Collaborators. \u003Cem\u003ELancet\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EThe ACC\/AHA guideline reflects the strong evidence that statin therapy at the appropriate intensity is of value to reduce the risk of ASCVD in patients with or without diabetes, stated Dr. Eckel. The lack of targets for LDL-C and non\u2014high-density lipoprotein cholesterol (non-HDL-C) is that there was no RCT evidence to support this. The guideline provides quantitative comparisons of the risk-benefit ratio with statins. Nonstatin therapies were not included in the guideline, because there is no evidence to support a reduction in ASCVD or a safety profile comparable with that of statins.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAdditional factors that are useful to make treatment decisions for patients who do not clearly fall into 1 of the 4 statin benefit groups are family history of premature ASCVD, higher lifetime risk of ASCVD, elevated LDL-C (\u2265 160 mg\/dL [4.13 mmol\/L]), elevated high-sensitivity C-reactive protein (\u2265 2.0 mg\/dL), and presence of subclinical atherosclerosis. Nonetheless, major issues remain: the validation of the risk estimator that is based on the diverse population in the National Health and Nutrition Examination Survey and provides lifetime and 10-year risk; the threshold of \u2265 7.5% 10-year cardiovascular (CV) disease risk to initiate statins for primary prevention; no target levels for LDL-C or non-HDL-C; and potential bias within the guideline-writing committee.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EDr. Eckel emphasized that the 2013 ACC\/AHA guideline is meant to guide, not dictate, treatment decisions, and it can and should be used to treat patients with diabetes.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EHenry N. Ginsberg, MD, Columbia University College of Physicians and Surgeons, New York City, New York, USA, argued against the use of the 2013 ACC\/AHA guideline for patients with diabetes. The major treatment recommendations from this guideline for statins to prevent ASCVD are presented in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/7\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Major Recommendations for Statin Therapy for Prevention of Atherosclerotic Cardiovascular Disease\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-522904148\u0022 data-figure-caption=\u0022Major Recommendations for Statin Therapy for Prevention of Atherosclerotic Cardiovascular Disease\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/7\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/7\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/19\/7\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14667\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003EMajor Recommendations for Statin Therapy for Prevention of Atherosclerotic Cardiovascular Disease\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EASCVD = atherosclerotic cardiovascular disease; LDL = low-density lipoprotein; y = year.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Stone NJ 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. \u003Cem\u003ECirculation.\u003C\/em\u003E 2014;129(suppl 2):S1-S45. With permission from Lippincott Williams and Wilkins.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-16\u0022\u003EThe key point is whether the 2013 ACC\/AHA guideline is strictly evidence based. The recommended treatment is a high-intensity statin for patients with and without diabetes. However, there is a caveat that there is no evidence from RCTs in patients with low LDL-C levels at baseline or in the very young or very elderly. Moreover, the treatment recommendations for patients with LDL-C \u2265 190 mg\/dL were based on consensus and expert opinion. Furthermore, some RCT data have favored the use of moderate-intensity statins for T2DM [Auer J et al. \u003Cem\u003ELancet\u003C\/em\u003E 2004], and the limited data for type 1 diabetes are from a meta-analysis (1466 of 18 686 patients) [\u003Cem\u003ELancet\u003C\/em\u003E 2008]. It is arguable, therefore, whether or not the ACC\/AHA guideline is strictly evidence based, stated Dr. Ginsberg.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003EDiabetes increases CV mortality compared with patients without diabetes, with a linear increase in risk as the number of risk factors increase (smoking, dyslipidemia, hypertension). The greater efficacy of atorvastatin at 80 mg compared with 10 mg in lowering LDL-C in high-risk patients was associated with greater reductions in the cumulative incidence of a first major CV event, nonfatal myocardial infarction, and death from coronary heart disease (CHD) [LaRosa JC et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2005]. Additionally, the efficacy of atorvastatin at 80 mg versus pravastatin at 40 mg in reducing both LDL-C and death due to a major CV event has been shown [Cannon CP et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2004]. These and 2 other similar trials have shown that greater reductions of LDL-C are associated with greater reductions in CHD events; therefore, there should be goals for LDL-C, such as those in ATP III or the 2006 ACC\/AHA guidelines. Use of nonstatin drugs to achieve those goals, if statin monotherapy fails to do so, seems reasonable and could have been offered as consensus or expert opinion.\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003ERegarding the threshold of \u2265 7.5% 10-year CV disease risk for people without diabetes or ASCVD, Dr. Ginsberg stated that no RCTs have randomly assigned patients by baseline risk and there are no RCT data to support this recommendation.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EThe American Diabetes Association recommendations for treating lipids are better than the ACC\/AHA guidelines for patients with diabetes, stated Dr. Ginsberg [American Diabetes Association. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013]. Its key recommendations are summarized in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E.\u003C\/p\u003E\u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14668\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14668\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14668\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n            \u003Cp id=\u0022p-20\u0022 class=\u0022first-child\u0022\u003EAmerican Diabetes Association Lipid Guidelines: Recommendations for Patients With Diabetes\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-22\u0022\u003EDr. Ginsberg stated that the ACC\/AHA guideline should have provided recommendations for treatment with agents other than statins when LDL-C is \u0026gt; 70 mg\/dL in patients who have CVD or are at very high risk. Also, the goals for total cholesterol and HDL-C should include diet and exercise, with nonstatin combination therapy considered for more severe dyslipidemia.\u003C\/p\u003E\u003Cp id=\u0022p-23\u0022\u003EIn summary, Dr. Ginsberg supported the identification of 4 groups of patients who, according to their high risk for CVD, deserved treatment with statins. However, he questioned 3 aspects of the 2013 ACC\/AHA guideline regarding the treatment of individuals in those 4 groups. First, previous guidelines had targets for LDL-C, while the new guideline advocates statin treatment with no regard for the ultimate LDL-C level. Second, previous guidelines linked statin intensity and LDL-C cutoffs and targets, while the latest guideline eliminates these yet still recommends different levels of statin intensity. Third, prior guidelines had no age-related cutoffs, while the current guideline has an upper limit of 75 years for its main recommendations.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/19\/7.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm3r1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}