A new ACC Expert Consensus Decision Pathway aims to fill the gap in clinical care for the management of high-risk atherosclerotic cardiovascular disease (ASCVD) patients with persistent hypertriglyceridemia and the incorporation of triglyceride nonstatin therapies.

The 2021 ACC Expert Consensus Decision Pathway on the Management of ASCVD Risk Reduction in Patients With Persistent Hypertriglyceridemia, published July 28 in the Journal of the American College of Cardiology, builds upon the evidence base of the 2018 AHA/ACC Guideline on the Management of Blood Cholesterol, and includes expert guidance published since the release of the guideline, including the REDUCE-IT trial.

Led by Salim S. Virani, MD, PhD, FACC, writing committee chair, and Pamela B. Morris, MD, FACC, writing committee vice chair, recommendations are provided for clinicians and patients regarding the use of statins and triglyceride nonstatin therapies to reduce the risk of ASCVD in patients with persistent hypertriglyceridemia who have established ASCVD, diabetes mellitus, severe hypertriglyceridemia and other high-risk factors.

Additionally, the document defines persistent hypertriglyceridemia, discusses the role of lifestyle intervention before consideration of triglyceride risk-based nonstatin therapies, addresses the role of statin therapy in patients with persistent hypertriglyceridemia, and identifies which patient populations triglyceride risk-based nonstatin therapies should be considered and the order of those therapies or agents being considered.

"After maximizing LDL-C lowering therapy, triglyceride lowering therapies may be considered to further lower ASCVD risk in patients with persistent hypertriglyceridemia," explain the authors. "Therapies that have been demonstrated to improve cardiovascular outcomes in primary and secondary prevention are preferred, keeping in mind net benefit (balance of risk and harms) of those therapies."

The document emphasizes that lifestyle intervention, including adherence to a heart-healthy diet, regular physical activity, avoidance of tobacco products, limited alcohol consumption and maintenance of a healthy weight remains a critical component of ASCVD risk reduction, both before and while patients are using lipid-lowering medications.

In addition, Virani and Morris add that "Use of medical nutrition therapy and leveraging all members of the cardiovascular team, including dietitians, are important in the management of persistent hypertriglyceridemia."

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Homozygous Familial Hypercholesterolemia, Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Diet, Exercise

Keywords: Cholesterol, Atherosclerosis, Diabetes Mellitus, Diet, Drug Therapy, Dyslipidemias, Exercise, Blood Glucose, Therapeutics, Hypercholesterolemia, Hypertriglyceridemia, Life Style, Risk Reduction Behavior, Lipids, Lipoproteins, Drug Therapy, Computer-Assisted, Motor Activity, Primary Prevention, Secondary Prevention, Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Triglycerides

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