NUEVAS GUÍAS AHA 2018 PARA EL MANEJO DEL COLESTEROL

1. 2018
AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/
APhA/ASPC/NLA/PCNA
Guias sobre el Manejo del Colesterol

3. 2018 Cholesterol Guideline Writing
Committee
Scott M. Grundy, MD, PhD, FAHA, Chair
Neil J. Stone, MD, FACC, FAHA, Vice Chair
*ACC/AHA Representative. †AACVPR Representative. ‡ACC/AHA Task Force on Clinical Practice Guidelines Liaison. §Prevention
Subcommittee Liaison. ║PCNA Representative. ¶AAPA Representative. **AGS Representative. ††ADA Representative. ‡‡PM
Representative. §§ACPM Representative. ║║NLA Representative. ¶¶APhA Representative. ***ASPC Representative. †††ABC
Representative
Alison L. Bailey, MD, FACC, FAACVPR†
Craig Beam, CRE*
Kim K. Birtcher, MS, PharmD, AACC, FNLA‡
Roger S. Blumenthal, MD, FACC, FAHA, FNLA§
Lynne T. Braun, PhD, CNP, FAHA, FPCNA, FNLA║
Sarah de Ferranti, MD, MPH*
Joseph Faiella-Tommasino, PhD, PA-C¶
Daniel E. Forman, MD, FAHA**
Ronald Goldberg, MD††
Paul A. Heidenreich, MD, MS, FACC, FAHA‡‡
Mark A. Hlatky, MD, FACC, FAHA*
Daniel W. Jones, MD, FAHA§
Donald Lloyd-Jones, MD, SCM, FACC, FAHA*
Nuria Lopez-Pajares, MD, MPH§§
Chiadi E. Ndumele, MD, PhD, FAHA*
Carl E. Orringer, MD, FACC, FNLA║║
Carmen A. Peralta, MD, MAS*
Joseph J. Saseen, PharmD, FNLA, FAHA¶¶
Sidney C. Smith, Jr, MD, MACC, FAHA*
Laurence Sperling, MD, FACC, FAHA, FASPC***
Salim S. Virani, MD, PhD, FACC, FAHA*
Joseph Yeboah, MD, MS, FACC, FAHA†††

4. Table 1. Applying Class
of Recommendation and
evel of Evidence to
Clinical Strategies,
Interventions,
Treatments, or
Diagnostic Testing
in Patient Care*
(Updated August 2015)

7. No. 1 Estilo de Vida Saludable

19. MASCULINO 37 AÑOS
DEPORTISTA DE ALTO RENDIMIENTO
INFARTO DEL MIOCARDIO INFERIOR, DURANTE EL ENTRENAMIENTO
INTERVENCION CORONARIA PERCUTANEA A LA ARTERIA CORONARIA
DERECHA

20. MASCULINO 37 AÑOS
DEPORTISTA DE ALTO RENDIMIENTO
INFARTO DEL MIOCARDIO INFERIOR, DURANTE EL ENTRENAMIENTO
INTERVENCION CORONARIA PERCUTANEA ALA ARTERIA CORONARIA
DERECHA

22. No. 1 ATEROSCLEROSIS CLINICA

23. MUJER 54 AÑOS
MADRE INFARTO A LOS 50 AÑOS
HIPERTENSA Y DISLIPIDEMICA (Hipercolesterolemia Familiar)
ANGINA DE RECIENTE INICIO
SCORE DE CALCIO 159
ANGIOTAC: Y ANGIOGRAFIA

24. VARON 70 AÑOS
HIPERTENSO
IAM ANTERIOR EXTENSO AGUDO
PRUEBA DE ESFUERZO POSITIVA PRECOZ
ANGIOGRAFIA
INFARTO DEL MIOCARDIO HACE 3 AÑOS SIN
ELEVCION ST CARA LATERAL

25. Table 4. Very High-Risk* of Future
ASCVD Events
Major ASCVD Events
Recent ACS (within the past 12 mo)
History of MI (other than recent ACS event listed above)
History of ischemic stroke
Symptomatic peripheral arterial disease (history of claudication
with ABI <0.85, or previous revascularization or amputation)

26. Table 4 continued
High-Risk Conditions
Age ≥65 y
Heterozygous familial hypercholesterolemia
History of prior coronary artery bypass surgery or percutaneous coronary
intervention outside of the major ASCVD event(s)
Diabetes mellitus
Hypertension
CKD (eGFR 15-59 mL/min/1.73 m2
)
Current smoking
Persistently elevated LDL-C (LDL-C ≥100 mg/dL [≥2.6 mmol/L]) despite maximally
tolerated statin therapy and ezetimibe
History of congestive HF

27. No. 3 PACIENTES CON
ATEOSCLEROSIS DE MUY ALTO
RIESGO

30. No. 5 PACIENTES CON DIABETES
MELLITUS

31. No. 5 PACIENTE CON DIABETES
MELLITUS
• PACIENTE FEMENINO
• 59 AÑOS
• RAZA BLANCA
• PA 120/67 mm Hg
• Ct 210 HDL 33 LDL 90
• DIABETES MELLITUS TIPO 2
• NO HIPERTENSION, NO TABAQUISMO,
• NO TOMA ESTATINAS
• NO TOMA ASIRINA

32. No. 5 PACIENTE CON DIABETES
MELLITUS

33. No. 5 PACIENTE CON DIABETES
MELLITUS

35. MASCULINO 40 AÑOS
APARENTEMENTE SANO
PRUEBAS CARDIACAS NORMALES
LDL PERSISTENTEMENTE EN 220 mg/dl
PADRE INFARTO A LOS 40 AÑOS

37. Severe Hypercholesterolemia (LDL-C ≥190
mg/dL [≥4.9 mmol/L])
Recommendations for Primary Severe Hypercholesterolemia (LDL-C ≥190 mg/dL
[≥4.9 mmol/L])
COR LOE Recommendations
IIb B-R
In patients 20 to 75 years of age with a baseline LDL-C level
≥190 mg/dL (≥4.9 mmol/L), who achieve less than a 50%
reduction in LDL-C levels and have fasting triglycerides ≤300
mg/dL (≤3.4 mmol/L). while taking maximally tolerated statin
and ezetimibe therapy, the addition of a bile acid sequestrant
may be considered.
IIb B-R
In patients 30 to 75 years of age with heterozygous FH and
with an LDL-C level of 100 mg/dL (≥2.6 mmol/L) or higher
while taking maximally tolerated statin and ezetimibe
therapy, the addition of a PCSK9 inhibitor may be considered.

42. ESTIMACION DE RIESGO PARA ENFERMEDAD CARDIOVASCULAR
ATEROSCLEROTICA

43. NO.6 PREVENCION PRIMARIA

48. No. 7 PACIENTES CON RIESGO
INTERMEDIO
• PACIENTE FEMENINO
• 53 AÑOS DE EDAD
• RAZA BLANCA
• PA 150/100 mm Hg
• CT 240, HDL 50, LDL 130
• DIABETES: NO
• TABAQUISMO: ACTUAL
• TRATAMIENTO ANTIHIPERTENSIVO: NO
• TRATAMIENTO ESTATINAS: NO
• TRATAMIENTO ASPIRINA: SI

49. No. 7 PACIENTES CON RIESGO
INTERMEDIO

50. No. 7 PACIENTES CON RIESGO
INTERMEDIO

51. No. 7 PACIENTES CON RIESGO
INTERMEDIO

52. No. 7 PACIENTES CON RIESGO
INTERMEDIO

53. No. 8 FACTORES QUE AUMENTAN RIESGO

54. No. 8 FACTORES QUE AUMENTAN RIESGO

55. No. 9 ADULTOS SIN DIABETES

58. No. 9 ADULTOS SIN DIABETES
(RIESGO INTERMEDIO)
PACIENTE MASCULINO
59 AÑOS DE EDAD
HISPANO
PA 130/90 mmHg
CT 220 HDL 55 LDL 96
DIABETES NO
TABAQUISMO: NUNCA
SIN TRATAMIENTO ANTIHIPERTENSIVO
SIN TRATAMIENTO DE ESTATINAS
SIN ASPIRINA

59. No. 9 ADULTOS SIN DIABETES
(RIESGO INTERMEDIO)

60. No. 10 ADHERENCIA AL
TRATAMIENTO8.

62. MASCULINO 54 AÑOS. .
RAZA HISPANO
PRESION 120 /77
COLESTEROL TOTAL 205
HDL 55 LDL 70
TRIGLICERIDOS 550 mg/dL
DIABETES. NO
TABACO SI
TRATAMIENTO ANTIHIPERTENISVO, NO
TRATAMIENTO ESTATINAS NO
TRATAMIENTO ASPIRINA NO

63. Hypertriglyceridemia
Recommendations for Hypertriglyceridemia
COR LOE Recommendations
IIa B-R
In adults 40 to 75 years of age with severe hypertriglyceridemia
(fasting triglycerides ≥500 mg/dL [≥5.6 mmol/L]) and ASCVD risk of
7.5% or higher, it is reasonable to address reversible causes of
high triglyceride and to initiate statin therapy.
IIa B-NR
In adults with severe hypertriglyceridemia (fasting triglycerides
≥500 mg/dL [≥5.7 mmol/L]), and especially fasting triglycerides
≥1000 mg/dL (11.3 mmol/L)), it is reasonable to identify and
address other causes of hypertriglyceridemia), and if triglycerides
are persistently elevated or increasing, to further reduce
triglycerides by implementation of a very low-fat diet, avoidance
of refined carbohydrates and alcohol, consumption of omega-3
fatty acids, and, if necessary to prevent acute pancreatitis, fibrate
therapy.