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The American Association of Clinical Endocrinologists (AACE) says it can’t support the new cardiovascular risk guidelines issued by the American Heart Association (AHA) and the American College of Cardiology (ACC), saying the set of 4 guideline documents is out of step with its own recommendations.

“AACE was asked to review and endorse the obesity and cholesterol guidelines. After careful consideration by the appropriate scientific committees of our organization, AACE declined to endorse these new cholesterol and obesity guidelines,” the organization said in a statement that was sent to its members in November and forwarded to the media today. “There are multiple reasons for this decision, including, principally, the incompatibility of these new guidelines with our existing guidelines.”

The 4 guidelines are:

• The treatment of blood cholesterol in adults.
• Lifestyle management to reduce cardiovascular risk .
• Obesity management, in conjunction with The Obesity Society.
• A “science advisory” on the management of hypertension, along with the Centers for Disease Control and Prevention.

All of the guidelines were issued with the support of the National Heart, Lung and Blood Institute, which had last updated its Adult Treatment Panel 3 (ATP3) National Cholesterol Education Panel (NCEP) guidelines for cholesterol and lipid management in 2004. AACE had “generally agreed” with those guidelines.

The endocrinology group faults the new AHA/ACC guidelines for focusing exclusively on randomized clinical trials and for not including studies published since 2011. “They are highly restrictive regarding the database considered and omit much new information… Taken together, these actions have resulted in a considerable number of at-risk patients being omitted from consideration.”

And, AACE says that the new cardiovascular disease calculator that was published along with the guidelines—and generated the most controversy—is already outdated. “It is based upon outmoded data, does not model the totality of the US population, has not been validated, and therefore has only limited applicability.”

As for new lipid guidelines, AACE disagrees with removal of the LDL targets and the idea that statin therapy alone is sufficient for all at-risk patients, noting that many who have multiple risk factors, including diabetes and established heart disease, will need additional therapies.

Finally, the new obesity guidelines, AACE says, “fail to classify obesity as a disease and continue the paradigm of [body-mass-index] BMI-centric risk stratification, both of which are contrary to recently stated AACE positions.” In addition, newly FDA-approved weight-loss medications are not included.

The statement concludes, “AACE welcomes the intent of the AHA and ACC in the creation of these new guidelines but does not agree with the complete content and therefore cannot endorse them.”

SOURCE

http://www.medscape.com/viewarticle/817810?nlid=42483_2105&src=wnl_edit_medp_card&uac=93761AJ&spon=2