AACE Does Not Endorse AHA/ACC Lipid and Obesity Guidelines
The American Association of Clinical Endocrinologists (AACE) currently does not endorse the new cholesterol and obesity guidelines from the American Heart Association (AHA)/American College of Cardiology (ACC), according to an AACE press statement. "AACE welcomes the intent of the AHA and ACC in the creation of these new guidelines but does not agree with the complete content and therefore cannot endorse them," the association stated.
The rationale behind this decision primarily comes from the incompatibility of the new guidelines with AACE existing guidelines, questions over the scientific evidence behind the new guidelines, and concerns that the populations of patients at risk from disease may be "underserved or ill-considered" using the AHA/ACC guidelines.
"These new guidelines from AHA/ACC focus exclusively on large-scale randomized clinical trials. They are highly restrictive regarding the database considered and omit much new information. Furthermore, no research after 2011 has been considered. Taken together, these actions have resulted in a considerable number of at-risk patients being omitted from consideration," according to the AACE statement.
In addition, the risk calculator for coronary heart disease released in the guidelines "is based upon outmoded data, does not model the totality of the U.S. population, has not been validated, and therefore has only limited applicability," according to the AACE statement.
AACE Calls for LDL Goals and Inclusion of Non-Statin Therapies
Furthermore, while AACE agrees with the use of the full dose of statins for dyslipidemia, the organization disagrees with the removal of low density lipoprotein (LDL) cholesterol goals and the idea that statin monotherapy is sufficient for all at-risk patients.
"Non-statin agents may be needed in combination with statins in very high risk groups to produce adequate LDL-cholesterol reduction to further reduce CHD risk," according to AACE. "Failure to set targets for treatment makes the degree of risk reduction produced in these groups unknowable and eliminates proper monitoring of management. Worse, it diverts attention away from the ongoing disease process and may lead to unjustified complacency regarding disease recurrence and its prevention," AACE stated.
Obesity Not Classified As a Disease in AHA/ACC Guidelines
The new obesity guidelines from the AHA/ACC along with The Obesity Society do not classify obesity as a disease and use a BMI-based risk stratification, both of which are contrary to recent AACE positions. Moreover, the AHA/ACC guidelines do not include any of the new FDA-approved medications for weight loss and instead focus primarily on lifestyle interventions and bariatric surgery which may not be sufficient for all patients with overweight or obesity-related complications, according to AACE.
AACE is currently thoroughly reviewing all four of the AHA/ACC guidelines and the science advisory on the management of hypertension, and will release comments in the near future. "We recommend that AACE members continue to refer to AACE guidelines and position statements on lipids and obesity to assist decision making in their practices," the association stated.