The Living Guidelines: UA/NSTEMI Recommendations for Lipid Management Suggest Revisions to the CLASS IIa Guidelines

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Class IIa Guidelines

1. The following lipid management strategies can be beneficial:

a. Further reduction of LDL-C to <70 mg/dL is reasonable. (Level of Evidence: A) [1] [2]
b. If baseline LDL cholesterol is 70-100 mg/dL, it is reasonable to treat LDL-C to less than 70 mg/dL. (Level of Evidence: B) [1] [2]
c. Further reduction of non HDL-C to <100 mg/dL is reasonable; if triglycerides are 200 to 499 mg/dL, non HDL-C target is <130 mg/dL. (Level of Evidence: B) [1] [2]
d. Therapeutic options to reduce non-HDL-C (after LDL-C lowering) include niacin or fibrate therapy. [1] [2]
e. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C– lowering therapy) for HDL-C <40 mg/dL. (Level of Evidence: B) [1] [2]
f. Nicotinic acid (niacin) and fibric acid derivatives (fenofibrate, gemfibrozil) can be useful as therapeutic options (after LDL-C lowering therapy) for triglycerides >200 mg/dL. (Level of Evidence: B) [1] [2]
g. The addition of plant stanol/sterols (2 g/day) and/or viscous fiber (>10 g/day) is reasonable to further lower LDL-C. (Level of Evidence: A) [1] [2]

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction). Circulation 2007 116: e148 – e304. PMID 17679616
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, Chavey WE II, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS. Correction of ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008 Mar 4; 51(9): 974. PMID 17692738



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