Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality worldwide. Over the last several decades, our understanding of the risk factors and ways to manage modifiable risks through lifestyle changes or therapeutic interventions has significantly improved the mortality rate. Furthermore, evidence-based clinical practice guidelines surrounding the management of ASCVD have provided a framework for clinical decisions and supporting best practices.
In November 2018, the American College of Cardiology (ACC) and American Heart Association (AHA), along with many additional collaborating organizations, published new practice guidelines for managing blood cholesterol. This is a 5-year update to the guidelines published in 2013. The 2013 guidelines were controversial due to the emphasis on statins as the sole therapy without defining LDL-C targets. This recommendation also differs from the decades old ATP III guidelines which used LDL-C goals for prevention and treatment.
Furthermore, the 10-year risk calculator using the pooled cohort equation was highly criticized as it was thought to overestimate risk in certain populations, leading to the overuse of statins.
Attendees at today’s session, “Cardiovascular Precision Medicine: The Laboratory’s Role in Advancing Personalized Patient Care,” will learn about the key features of the new guidelines, with an added twist of incorporating precision medicine into the mix.
Many improvements in the AHA/ACC guidelines are relevant to clinical laboratorians, and in the session, speaker Sridevi Devaraj, PhD, will explore how they can play an active role in incorporating these into the current testing modalities for cardiovascular risk and prevention.
Jin Cao, PhD, will discuss how the new guidelines include renewed LDL-C treatment targets in primary and secondary prevention and much more, including use of non-fasting lipids, new calculations of LDL-C, and recommendations on assessing risk-enhancing factors in certain patient populations to help clinicians decide on statin and non-statin therapy.
Cao also will explain why the standard lipid panel is not the only set of laboratory parameters to consider. The new guidelines incorporate non-traditional risk factors such as chronic inflammatory conditions, chronic kidney disease, metabolic syndrome, preeclampsia, and persistently elevated LDL-C, among others. As such, laboratory parameters that may be measured in determining whether lipid lowering therapy is needed could include CRP, urine albumin, creatinine, apolipoprotein, and lipoprotein (a).
So where does precision medicine fall into all this? Devaraja will explore how precision medicine can target a complex multifactorial disease such as atherothrombosis, and how precision medicine offers a new strategy for the care and management of patients that takes into account individual differences in genetics, environment, and lifestyle.
The speakers will emphasize how the laboratory can play an integral role in delivering individualized risk assessment and treatment options based on a number of lab results, family history, clinical findings, and/or imaging studies. And they will shed light on their vision of using an advanced EMR system that can combine these elements and help clinicians not only in diagnosis but also in making decisions on lifestyle coaching and therapeutic intervention.
As for how the ACC/AHA addressed the controversy surrounding the pooled cohort equation, conference goers will need to attend the session to get the scoop.