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Have the AHA/ACC CVD guidelines changed your practice?

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I've been reviewing via Medscape the specifics behind the AHA/ACC guideline changes in 11/13 and am curious if folks are modifying their treatment parameters (fewer statins, or actually taking some off statins), and more specifically, are you ordering more/same/fewer Calcium Index Score studies based specifically on these guidelines?  USPSTF still has these classified as "poor to fair value", though this recommendation was made several years back.  I must confess that I've never fully understood the recommendation behind these studies for PRIMARY prevention since I have always understood that high calcium plaques are considered "stable", whereas the low calcium, thus not seen on CT, are the less stable, and thus higher risk plaques.  For those who may be interested, app stores have this latest risk calculator available for free download.  Primary risk groups for statin therapy are:

1. People who already have cardiovascular disease;

2. People who have an LDL-C level ≥ 190 mg/dL (primary elevation);

3. People who have diabetes and are aged 40-75 years; and

4. The primary prevention group where the 10-year risk is above 7.5%


I must confess, I wasn't familiar with the PCSK9 Inhibitors for those intolerant of statins, or who can't obtain treatment goals with statins (injectable q2 wks/q mo.).

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