Management of Dyslipidemia for Cardiovascular Disease Risk Reduction: Synopsis of the 2020 Updated U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline

O'Malley, Patrick G. MD, MPH
Arnold, Michael J. MD
Kelley, Cathy PharmD
Spacek, Lance MD
Buelt, Andrew DO
Natarajan, Sundar MD, MSc
Donahue, Mark P. MD
Vagichev, Elena PharmD
Ballard-Hernandez, Jennifer DNP, FNP-BC
Logan, Amanda MPS, RDN, LD
Thomas, Lauren MS, RDN, LD
Ritter, Joan MD
Neubauer, Brian E. MD, MHPE
Downs, John R. MD

Uniformed Services University of the Health Sciences, Bethesda, Maryland (P.G.O., M.J.A., B.E.N.)
U.S. Department of Veterans Affairs Pharmacy Benefits Management Services, Scottsdale, Arizona (C.K.)
South Texas Veterans Health Care System and University of Texas Health Science Center, San Antonio, Texas (L.S., J.R.D.)
Bay Pines VA Healthcare System, Bay Pines, Florida (A.B.)
New York University School of Medicine and VA New York Harbor Healthcare System, New York, New York (S.N.)
Duke University Medical Center and Durham VA Medical Center, Durham, North Carolina (M.P.D.)
Walter Reed National Military Medical Center, Bethesda, Maryland (E.V., L.T.)
Tibor Rubin VA Medical Center, Long Beach, California (J.B.)
Cincinnati VA Medical Center, Cincinnati, Ohio (A.L.)
Walter Reed Military Medical Center and Uniformed Services University of the Health Sciences, Bethesda, Maryland (J.R.)

Disclaimer: The views expressed here are of the authors, and are not to be construed as those of the VA or DoD.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-4648.

Corresponding Author: Patrick G. O'Malley, MD, MPH, Department of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814; e-mail, [email protected].

Current Author Addresses: Drs. O'Malley, Ritter, and Neubauer: Department of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.

Dr. Arnold: Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.

Dr. Kelley: VA Pharmacy Benefits Management Services, 22948 North 79th Place, Scottsdale, AZ 85255.

Drs. Spacek and Downs: Department of Medicine, South Texas Veterans Health Care System, Medicine Service, 7400 Merton Minter Boulevard, San Antonio, TX 78229.

Dr. Buelt: Medicine Service, Bay Pines VA Healthcare System, 10000 Bay Pines Boulevard, Bay Pines, FL 33744.

Dr. Natarajan: VA New York Harbor Healthcare System, 423 East 23rd Street, Room 15160-N, New York, NY 10010.

Dr. Donahue: 108 South Bend Drive, Durham, NC 27713.

Dr. Vagichev and Ms. Thomas: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.

Dr. Ballard-Hernandez: 21121 Amberwick Lane, Huntington Beach, CA 92646.

Ms. Logan: 3775 Lincoln Road, Cincinnati, OH 45247.

Author Contributions: Conception and design: P.G. O'Malley, L. Spacek, S. Natarajan, J. Ballard-Hernandez, J. Ritter, B.E. Neubauer.

Analysis and interpretation of the data: P.G. O'Malley, M.J. Arnold, C. Kelley, L. Spacek, A. Buelt, S. Natarajan, E. Vagichev, J. Ballard-Hernandez, A. Logan, L. Thomas, J. Ritter, B.E. Neubauer, J.R. Downs.

Drafting of the article: P.G. O'Malley, M.J. Arnold, C. Kelley, L. Spacek, A. Buelt, S. Natarajan, M.P. Donahue, E. Vagichev, J. Ballard-Hernandez, A. Logan, L. Thomas, J. Ritter, B.E. Neubauer, J.R. Downs.

Critical revision for important intellectual content: P.G. O'Malley, C. Kelley, L. Spacek, S. Natarajan, M.P. Donahue, J. Ballard-Hernandez, A. Logan, L. Thomas, J. Ritter, B.E. Neubauer, J.R. Downs.

Final approval of the article: P.G. O'Malley, M.J. Arnold, C. Kelley, L. Spacek, A. Buelt, S. Natarajan, M.P. Donahue, E. Vagichev, J. Ballard-Hernandez, A. Logan, L. Thomas, J. Ritter, B.E. Neubauer, J.R. Downs.

Provision of study materials or patients: P.G. O'Malley.

Statistical expertise: P.G. O'Malley.

Administrative, technical, or logistic support: P.G. O'Malley, B.E. Neubauer.

Collection and assembly of data: P.G. O'Malley, M.J. Arnold, S. Natarajan, J. Ballard-Hernandez, B.E. Neubauer.

Annals of Internal Medicine - Latest , September 23, 2020. | DOI: 10.7326/M20-4648

This 2020 clinical practice guideline from the U.S. Department of Veterans Affairs and U.S. Department of Defense includes major recommendations for managing dyslipidemia in adults. Topics include targeting of statin dosage, tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition.

Description:

In June 2020, the U.S. Department of Veterans Affairs (VA) and U.S. Department of Defense (DoD) released a joint update of their clinical practice guideline for managing dyslipidemia to reduce cardiovascular disease risk in adults. This synopsis describes the major recommendations.

Methods:

On 6 August to 9 August 2019, the VA/DoD Evidence-Based Practice Work Group (EBPWG) convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions, systematically searched and evaluated the literature (English-language publications from 1 December 2013 to 16 May 2019), and developed 27 recommendations and a simple 1-page algorithm. The recommendations were graded by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.

Recommendations:

This synopsis summarizes key features of the guideline in 7 crucial areas: targeting of statin dose (not low-density lipoprotein cholesterol goals), additional tests for risk prediction, primary and secondary prevention, laboratory testing, physical activity, and nutrition.