AACE/ACE Focus on Lipids: 2017 Consensus Guidelines

November 7, 2017
Veronica Hackenthal, MD

The AACE/ACE 2017 recommendations on lipid management renew focus on LDL-C targets, and go far lower than any group has ventured to date.

Taking a small step back in time, the lipid management guidelines issued by the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) earlier in 2017 re-affirm the use of LDL-C targets to help minimize cardiovascular risk in all patients, and especially those with type 2 diabetes (T2DM). The guideline includes a first-ever "extreme risk" patient category for whom an LDL-C level of

AACE/ACE Updated Guidelines on T2D Managment emphasize early intensive management of dyslipidemia to decrease significant risk of ASCVD in T2D.
 

New independent ASCVD risk factors added: polycystic ovarian syndrome, CKD stage 3-4, signs of coronary artery calcification.

Guideline sets cutoffs for very high risk (T2D + ≥ 1 risk factor) and high risk (T2D, no other risk factors and/or age < 40y) for LDL-C, non-HDL-C, triglycerides, and apo B.

New ASCVD "extreme risk" category added to AACE/ACE T2DM guideline: T2D plus prior ASCVD event (“clinical” ASCVD) or CKD stage 3-4; first organization to include recommendation for LDL-C reduction to < 55 mg/dL.

AACE/ACE note lipid particle management may be useful however, there is currently no evidence to establish target goals.

Guideline prescribes primary, secondary management: recommends statin drugs as first-line therapy with intensification and adjunct medications added as required to reach targeted therapeutic levels.

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