In the discussion to follow, several specific aspects of comparison of the two sets of guidelines can be reviewed. Still, these drugs can be used if deemed appropriate by clinical judgment. The other lipid-lowering drugs-bile acid sequestrants, ezetimibe, fibrates, and nicotinic acid-were largely discounted because of lack of sufficient RCT studies. Drug recommendations apply only to statins, which have the strongest RCT evidence. Seemingly, these rules are applied only to drug therapy. In so doing, the new guideline panel broke their own evidence-based rules. An interesting aspect of the ACC/AHA guidelines is that lifestyle is promoted without RCT evidence. Evidence statements based on various types of scientific data were developed to stand behind recommendations.īoth ATP III and ACC/AHA guidelines emphasize the value of lifestyle intervention. It emphasized RCTs, but where appropriate, used epidemiological data, genetic and metabolic studies, and various in vivo and in vitro investigations to flesh out the guidelines. In contrast, the ATP III panel made use of all types of relevant science. These two organizations transformed NHLBI's evidence reviews into treatment guidelines. Recently, the NHLBI made a decision to discontinue the development of clinical guidelines and instead to provide their evidence review to the ACC and AHA. This means that the new guidelines left clinicians in the position of having to use their own clinical judgment to arrive at many clinical decisions instead of having science-based guidance to inform these clinical choices. The virtual exclusion of other types of evidence greatly restricted the scope of the new guidelines. In other words, recommendations should be based mainly on evidence obtained by randomized clinical trials (RCTs). The IOM emphasized the necessity for "evidence-based medicine" in guideline development. The so-called "ATP IV" panel followed the "rules" for guideline development published by a committee of the Institute of Medicine (IOM) ( ). The most recent guideline update process was started several years ago under the auspices of the National Heart Lung and Blood Institute (NHLBI). Before comparing the new guidelines with ATP III a few comments about ACC/AHA recommendations may be in order. 2 The ACC/AHA guidelines in fact constitute a new paradigm for cholesterol management. 1 These guidelines were designed to update the previous Adult Treatment Panel III (ATP III) report of the National Cholesterol Education Program (NCEP). The American College of Cardiology (ACC) and the American Heart Association (AHA) recently released new guidelines for treatment of high blood cholesterol. Comparison of ATP III and ACC/AHA Guidelines
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