Strong>VA/DOD guidelines differ from ACC/AHA guidelines in several aspects
The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of dyslipidemia for cardiovascular disease (CVD) risk reduction in adults. A synopsis of the guideline is published in Annals of Internal Medicine.
The synopsis summarizes key features of the guideline in five areas: elimination of treatment targets; additional tests for risk prediction; primary and secondary prevention; and laboratory testing. According to the authors, the guidelines differ from the American College of Cardiology and American Heart Association (ACC/AHA) guidelines in several aspects.
Both the ACC/AHA and VA/DoD guidelines recommend the elimination of treatment targets. However, the VA/DoD guidelines include an extended review of the research through February 2014. With regard to additional tests to refine risk prediction, the VA/DoD guidelines are more conservative, recommending these tests only when the rationale is clear. Once the patient's 10-year risk has been calculated, the VA/DoD recommends shared decision-making to determine whether the potential benefits of medications outweigh the potential harms for each patient, which is a more nuanced approach than that of the ACC/AHA. The VA/DoD recommends that patients be treated with a moderate-dose statin first, then titrate to a high dose in patients at the highest risk. The authors cite safety concerns as the rationale for this recommendation. The VA/DoD recommendations call for nonfasting laboratory tests, and once a statin is initiated, they do not recommend routine monitoring of lipids. Finally, the authors of the VA/DoD guideline say their group contained members with no conflicts of interest.