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Am J Med. 2016 Sep;129(9):906-12. doi: 10.1016/j.amjmed.2016.04.012. Epub 2016 May 3.

Lipid Management Guidelines from the Departments of Veteran Affairs and Defense: A Critique.

Author information

1
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
2
Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Md.
3
Michael E. DeBakey Veterans Affairs Medical Center and Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex.
4
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md.
5
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: jmcevoy1@jhmi.edu.

Abstract

In December 2014, the US Department of Veterans Affairs and Department of Defense (VA/DoD) published an independent clinical practice guideline for the management of dyslipidemia and cardiovascular disease risk, adding to the myriad of recently published guidelines on this topic. The VA/DoD guidelines differ from major US guidelines published by the American College of Cardiology/American Heart Association in 2013 in the following ways: recommending moderate-intensity statins for the majority of patients with statin indications regardless of atherosclerotic cardiovascular disease risk; advocating for limited on-treatment lipid monitoring; and deemphasizing ancillary data, such as coronary artery calcium testing, to improve atherosclerotic cardiovascular disease risk estimation. In the context of manifold treatment recommendations from numerous guideline committees, the VA/DoD recommendations may generate further confusion and mixed messages among healthcare providers about the optimal treatment of dyslipidemia. In this review, we critically appraise the VA/DoD recommendations with a focus on the evidence base for each area where the VA/DoD guidelines differ from the American College of Cardiology/American Heart Association guidelines. We also call for harmonization of lipid treatment guidelines to ensure high-quality and consistent care for patients with, and at risk for, atherosclerotic cardiovascular disease.

KEYWORDS:

Atherosclerotic cardiovascular disease; Coronary artery calcium; Dyslipidemia; Guidelines; Veterans Affairs

PMID:
27154781
DOI:
10.1016/j.amjmed.2016.04.012
[Indexed for MEDLINE]

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