NLA Cholesterol Guidelines

The National Lipid Association recently released their recommendations for the management of dyslipidemia. The NLA guidelines have a few different thoughts compared to the 2013 AHA/ACC guidelines. One major change is that the NLA has set specific treatment goals for both LDL-C and non-HDL-C based on risk categories and when to consider initiating therapy.

They stated that non-HDL-C is the cholesterol that is carried by all potentially atherogenic particles (root cause of atherosclerosis), which is total cholesterol minus HDL-C.

If a patient is in the desired range, labs and ASVD risk assessment should be repeated in 5 years (or sooner if clinically needed).

		Treatment goals	Consider drug therapy
Risk category	Criteria	Non-HDL-C mg/dL ------------------ LDL-C mg/dL	Non-HDL-C mg/dL -------------------- LDL-C mg/dL
Low	• 0–1 major ASCVD risk factors • Consider other risk indicators, if known	<130	≥190
		<100	≥160
Moderate	• 2 major ASCVD risk factors • Consider quantitative risk scoring • Consider other risk indicators	<130	≥160
		<100	≥130
High	• ≥3 major ASCVD risk factors • Diabetes mellitus (type 1 or 2) ○ 0–1 other major ASCVD risk factors and ○ No evidence of end organ damage • Chronic kidney disease stage 3B or 4 • LDL-C ≥190 mg/dL (severe hypercholesterolemia) • Quantitative risk score reaching the high-risk threshold‖‖	<130	≥130
		<100	≥100
Very high	• ASCVD • Diabetes mellitus (type 1 or 2) ○ ≥2 other major ASCVD risk factors or ○ Evidence of end-organ damage	<100	≥100
		<70	≥70

Jacobson TA, et al. National Lipid Association recommendations for patient-centered management of dyslipidemia. Journal of Clinical Lipidology Volume 8, Issue 5, pages 473 - 488. 2014 National Lipid Association.