Patient-centered and practical application of new high cholesterol guidelines to prevent cardiovascular disease.

In 2013, the American College of Cardiology and the AmericanHeart Association (ACC/AHA) published new guidelines for assessing cardiovascular disease (CVD) risk1 and for treatment of blood cholesterol to reduce CVD.2 These new guidelines replaced the Adult TreatmentPanel III (ATPIII)guidelines for thedetection,evaluation, and treatment of high blood cholesterol3 that guidedclinical practice formore thanadecade.Thenew guidelines divert focus from lowering low-density lipoprotein (LDL) cholesterol levels to treatingCVDrisk and therefore are no longer pure cholesterol guidelines like theATP III predecessor.Thenewguidelinesalsodiscourage theprescriptionof lipid-loweringmedications, such asezetimibeorniacin, thatdonothaveproveneffecton reducingCVDrisk.Thesechanges representamajorshift in preventive cardiology. To apply the ACC/AHA guidelines in a patientcenteredandpractical perspective, 3 cases illustrate the evidence-based approach espoused by the new guidelines, with 1 importantmodification. The guidelines set