IJCS | Volume 32, Nº6, November / December 2019

638 Table 2 - Risk-Enhancing Factors • Family history of premature ASCVD - (men < 55 years; women < 65 years) • Primary hypercholesterolemia (LDL-C 160-189 mg/dl; non-HDL-C 190-219 mg/dl • Metabolic syndrome • Chronic kidney disease (eGFR 15- 59 ml/min per 1.73 m 2 ) • Chronic inflammatory conditions: psoriasis, rheumatoid arthritis (RA) or human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) • History of premature menopause (before age 40) and history pre-eclampsia at pregnancy • High-risk ethnicities (e.g. South Asian) • Lipid/Biomarkers: a. Persistently elevated, primary hypertriglyceridemia (≥ 175 mg/dl); b. If measured: • High-sensitivity C-reactive protein ≥ 2.0 mg/L • Lp(a) ≥ 50 mg/dL or ≥ 125 nmol/L • Apo B ≥ 130 mg/dL • ABI < 0.9 AIDS: acquired immunodeficiency syndrome; ABI: ankle-brachial index; apoB: apolipoprotein B; ASCVD: atherosclerotic cardiovascular disease; eGFR: estimated glomerular filtration rate; HDL-c: high- density lipoprotein cholesterol; HIV: human immunodeficiency virus; LDL-c: low-density lipoprotein cholesterol; Lp(a): lipoprotein (a); and RA: rheumatoid arthritis. In conclusion, even though the clinical risk stratification followed by selective use of preventative pharmacological interventions is still the main strategy of primary prevention, these newguidelines allow individualization of treatment by complementary risk stratification, new therapies and facilitation of patient involvement in a shared decision making process. Author contributions Conception and design of the research: Generoso G, BittencourtMS.Acquisitionof data:GenerosoG, Bittencourt MS. Analysis and interpretation of the data: Generoso G, Bittencourt MS. Writing of the manuscript: Generoso G, Bittencourt MS. Critical revision of the manuscript for intellectual content: Generoso G, Bittencourt MS. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/ APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: AReport of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;73(24):e285-e350. 2. Boekholdt SM, HovinghGK, Mora S, Arsenault BJ, Amarenco P, Pedersen TR, et al. Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. J AmColl Cardiol. 2014;64(5):485-94. 3. Yeboah J, Young R, McClelland RL, Delaney JC, Polonsky TS, Dawood FZ, et al. Utility of nontraditional risk markers in atherosclerotic cardiovascular disease risk assessment. J Am Coll Cardiol. 2016;67(2):139-47. 4. Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374(21):2021-31. 5. Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the multi-ethnic study of atherosclerosis (MESA). Circulation. 2016;133(9):849-58. 6. Besseling J, Hovingh GK, Huijgen R, Kastelein JJP, Hutten BA. Statins in familial hypercholesterolemia: consequences for coronary artery disease and all-cause mortality. J Am Coll Cardiol. 2016;68(3):252-60. References Bittencourt & Generoso New ACC/AHA cholesterol guidelines Int J Cardiovasc Sci. 2019;32(6):635-638 Review Article This is an open-access article distributed under the terms of the Creative Commons Attribution License