Introduction of New Cardiovascular “Extreme Risk” Category, Clinical Guidelines Validated at Summit of International Endocrinologists

AUSTIN, Texas--()--Dyslipidemia management experts speaking today at the American Association of Clinical Endocrinologists’ 26th Annual Scientific and Clinical Congress highlighted the patient benefits of recently introduced clinical guidelines, the American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease, which recommend more intense treatment and intervention.

Using case-based evidence in their “Meet the Experts” workshop, presenters Dr. Paul Jellinger and Dr. Yehuda Handelsman underscored the application of more aggressive treatment for reduction of low-density lipoprotein cholesterol (LDL-C) in patients with progressive ASCVD who have achieved an LDL under 70; those with established ASCVD and diabetes, stage 3 or 4 chronic kidney disease, or heterozygous familial hypercholesterolemia; and those with a history of premature cardiovascular disease, all of whom are categorized in a newly introduced cardiovascular “extreme risk” category. Treatment goals for patients in the extreme risk category include LDL cholesterol <55mg/dL, non-HDL cholesterol <80mg/dL, and ApoB <70mg/dL.

Their presentation also highlighted the value of coronary artery calcium (CAC) score and inflammatory markers to stratify risk.

The groundbreaking guidelines further provide an assessment of the value of adding ezetimibe and PCSK9 inhibitors in patients with cardiovascular disease who are unable to reach LDL cholesterol goals with statin therapy; screening for cardiovascular risk in female patients using the Reynolds Risk Score or the Framingham Risk Assessment Tool; and special guidance for the diagnosis and management of dyslipidemia in children and adolescents as early as possible to decrease the long-term risk of adult cardiovascular events (See Risk Stratification Chart below).

“While suggestive evidence pointed in the direction of better outcomes with more aggressive LDL treatment, the IMPROVE-IT trial was the first prospective demonstrated clearly that driving LDL down to 53 provided a clear, significant benefit in reducing cardiovascular outcomes in high-risk groups,” noted Dr. Jellinger.“By expanding the group of patients studied in IMPROVE-IT to other very high-risk situations, our knowledge base expanded considerably, leading to the creation of the new risk category, a broader range of disease stages, and the accompanying groundbreaking treatment and intervention recommendations.” (See chart below).


Atherosclerotic Cardiovascular Disease Risk Categories and

Low-Density Lipoprotein Treatment Goals

Risk category  


Risk factorsa/10-year riskb   Treatment goals







Apo B


Extreme Risk

– Progressive ASCVD including unstable angina in patients after achieving an LDL-C 70 mg/dL

  55   80   70
– Established clinical cardiovascular disease in patients with DM, CKD 3/4, or HeFH
– History of premature ASCVD (55 male, 65 female)
Very High Risk – Established or recent hospitalization for ACS, coronary, carotid or peripheral vascular disease, 10-year risk >20% 70 100 80
– Diabetes or CKD 3/4 with 1 or more risk factor(s)
    – HeFH      
High Risk – ≥2 risk factors and 10-year risk 10%-20% 100 130 90
– Diabetes or CKD 3/4 with no other risk factors
Moderate Risk     ≤2 risk factors and 10-year risk <10%   <100   <130   <90
Low Risk     0 risk factors   <130   <160   NR

About the American Association of Clinical Endocrinologists (AACE)

The American Association of Clinical Endocrinologists (AACE) represents more than 7,000 endocrinologists in the United States and abroad. AACE is the largest association of clinical endocrinologists in the world. A majority of AACE members are certified in endocrinology, diabetes and metabolism and concentrate on the treatment of patients with endocrine and metabolic disorders including diabetes, thyroid disorders, osteoporosis, growth hormone deficiency, cholesterol disorders, hypertension and obesity. Visit our site at

About the American College of Endocrinology (ACE)

The American College of Endocrinology (ACE) is the educational and scientific arm of the American Association of Clinical Endocrinologists (AACE). ACE is the leader in advancing the care and prevention of endocrine and metabolic disorders by: providing professional education and reliable public health information; recognizing excellence in education, research and service; promoting clinical research and defining the future of Clinical Endocrinology. For more information, please visit


American Association of Clinical Endocrinologists
Mary Green, 407-506-2960


American Association of Clinical Endocrinologists
Mary Green, 407-506-2960