The authors review more than three decades of progress in providing clinicians and patients with guidance on risk assessment, patient evaluation and cholesterol management. Beginning with the National Cholesterol Education Program's Initial Adult Treatment Panel report, the cholesterol guidelines increasingly reflect the progress made in understanding the benefits of improved lifestyle and nutrition to improve lipid profiles, major risk factors and reduce ASCVD risk. Moreover, they now provide qualitative and quantitative assessment tools to guide appropriate risk reduction LDL-C lowering therapy. Use of the Pooled Cohort Equations to determine Low, Borderline, Intermediate and High 10-year ASCVD risk is now joined by recognition of conditions and biomarkers that enhance ASCVD risk. This personalizes the risk discussion for the patient. An important addition is the selective use of coronary artery calcium (CAC) scoring to reclassify risk in patients at borderline or intermediate risk, but for whom a risk decision regarding statin therapy is uncertain. In secondary prevention, current guidelines provide criteria for determining a "very high" risk group in whom risk is especially high and in whom aggressive LDL-C lowering can be shown to provide increased absolute benefit. Current guidelines provide a comprehensive look at children and adolescents, young adults, elderly, women and issues specific to women through the life course. They provide guidance for those adults at risk due to severe hypercholesterolemia, persistent hypertriglyceridemia after secondary causes have been addressed, those with inflammatory disorders and HIV, those adults with chronic kidney disease, and those affected by issues of race/ethnicity. They conclude with a brief summary of recommendations emphasizing important concepts for providing safety with LDL-C lowering therapy. This combination of best external evidence and clinical expertise from the expert panel should provide a solid foundation for lipid management of patients at risk for or with clinical ASCVD.

中文翻译：

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2018 AHA/ACC/多社会胆固醇指南：回顾过去、现在和未来。

作者回顾了三十年来在为临床医生和患者提供风险评估、患者评估和胆固醇管理指导方面取得的进展。从国家胆固醇教育计划的初始成人治疗小组报告开始，胆固醇指南越来越多地反映了在了解改善生活方式和营养对改善血脂、主要危险因素和降低 ASCVD 风险的益处方面取得的进展。此外，他们现在提供定性和定量评估工具来指导适当的风险降低 LDL-C 降低治疗。使用合并队列方程来确定低、临界、中和高 10 年 ASCVD 风险，现在与提高 ASCVD 风险的条件和生物标志物的识别相结合。这使患者的风险讨论个性化。一个重要的补充是选择性使用冠状动脉钙化 (CAC) 评分来重新分类处于临界或中等风险但对他汀类药物治疗的风险决策不确定的患者的风险。在二级预防中，目前的指南提供了确定“非常高”风险组的标准，在这些组中风险特别高，并且可以证明积极降低 LDL-C 可以提供增加的绝对益处。当前的指南全面审视了儿童和青少年、年轻人、老年人、妇女以及妇女在整个生命过程中的特定问题。它们为那些因严重高胆固醇血症、继发性原因得到解决后持续性高甘油三酯血症、患有炎症性疾病和 HIV 的成年人、患有慢性肾病的成年人、以及受种族/民族问题影响的人。他们最后简要总结了建议，强调了为降低 LDL-C 治疗提供安全性的重要概念。这种来自专家组的最佳外部证据和临床专业知识的结合应该为有临床 ASCVD 风险或患有临床 ASCVD 的患者的脂质管理提供坚实的基础。