The Cholesterol Wars are raging again! Dr Daniel Steinberg’s best seller chronicling the rise of statins and the “fight” around the “lipid hypothesis” is likely to come back into the limelight with the launch of the ACC’s latest cholesterol app. In 2013, the ACC released new cholesterol guidelines that moved away from LDL-C treatment targets and launched their controversial Pooled Equations calculator. Nearly four years and their excellent ASCVD app later, those guidelines are well entrenched in primary care.
However, many cardiologists and lipidologists cried foul over the seeming removal of LDL targets. The National Lipid Association launched their own guideline bringing them back. This group receives significant pharmaceutical funding however. The publication of the IMPROVE-IT trial demonstrated some additional benefit of aggressive lipid lowering in patients with acute coronary syndrome by the addition of ezetimibe to moderate intensity simvastatin. This study has its flaws and critics, but also brought back the “lower is better” discussion. In 2016, the ACC supplemented their 2013 guidelines by focusing on LDL management and similar to the National Lipid Foundation’s guideline, appeared to bring us Back to the Future of ATP III with additional recommendations on treating to LDL targets.
The American College of Cardiology (ACC) has been producing some outstanding apps. Previously on iMedicalApps we reviewed their outstanding ASCVD, Anticoag Evaluator, DAPT calculator, and BridgeAnticoag apps. Their latest medical app, LDL-C Manager combines all three of their cholesterol apps in one: ASCVD, Statin Intolerance, LDL-C Lowering Therapy. I predict this medical app will be a blockbuster similar to ASCVD. I am curious to see how it will change clinical practice: will it lead to more prescriptions for higher intensity statins and more prescriptions for ezetimibe?
Clinical Scenario of LDL-C Manager Medical App
A 65 year-old male with a past medical history of myocardial infarction is on a high intensity dose of atorvastatin. His most recent lipid panel shows an LDL-C of 110. Should his lipid lowering treatment be modified. If so, how? What if the patient only had CV risk factors such as hypertension and Type II diabetes, but no known CAD?.
Video Review of the LDL-C Manager Medical app
Evidence based medicine
The ACC’s LDL-C Manager attempts to pool all of the ACC’s cholesterol guidelines into one app. A noble goal indeed. The medical app includes the primarily evidence based guideline that became the ACC/ATP IV cholesterol guidelines along with their recent supplement to those guidelines which seemingly brought back LDL targets. The app also includes their statin intolerance guideline. My gripe is the lack of evidence for some of the statin intensification regimens that providers will “calculate” in the app. This may lead to more patients on higher doses of statins than they need and/or additional medications such as ezetimibe and bile acid sequestrants which have their place, but using this calculator, would be prescribed more than current RCT evidence actually supports.
What providers would benefit from this Medical App?
Students, residents, mid-levels, Family Medicine, Internal Medicine, Emergency Medicine, Cardiology, anticoagulation clinic personnel. Any provider who prescribes or manages patients with hyperlipidemia and/or CV risk factors that may require statins.
Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.
- Easy to use, mostly intuitive interface for data input.
- Expert and evidence based outcome data with clear recommendations.
- Includes suggestive patient scripts for patient-provider discussions on recommendations.
- Available for Android
- App includes copious amounts of expert opinion that at times contradicts other more evidence-based guidelines.
- Statin intolerance module is a web app while the ASCVD app is combined seemlessly with the LDL-Manager portion.
- Minimal instructions on use of app.
The American College of Cardiology’s (ACC) LDL-C Manager is a must have medical app for anyone already using their excellent ASCVD app. The LDL-C Manger medical app combines three ACC products in one giving providers multiple guidelines for the management of cholesterol in one app. My only concern is the expert opinion throughout the “LDL Manager” portion of the app as it appears to take a step back to the ATP III guidelines of LDL treatment targets which in most cases are not based on RCT data. The app is available for both iOS and Android platforms.
- Overall Score
- User Interface
Intuitive, built in calculators, even patient scripts, but interface can be confusing at times.
- Multimedia Usage
App links to various ACC resources, CPGs, etc. but all are links; even the Statin Intolerance module is a weblink.
A great resource for free.
- Real World Applicability
This app could easily change the practice of many primary care providers by its combination of all three of the ACC’s cholesterol apps. However, the evidence supporting some of the app’s recommendation are based solely on expert opinion and the risks/benefits of LDL treatment intensification must be discussed with each patient appropriately.
- Device Used For Review
iPhone 6S running iOS 10.2.1
- Available for DownloadAndroidiPhoneiPad