Podcast Summary: AACE Podcast Episode 58 - 2025 AACE Dyslipidemia Guideline Methodology

Date: February 5, 2025
Host: Dr. David Lieb
Guests:

• Dr. Carol Peng (Methodology Fellow, Endocrinologist)
• Dr. Shenaz Sultan (Professor of Medicine, Gastroenterology, GRADE expert)
• Dr. Melanie Bird (ACE Guideline Program Methodologist)

Episode Overview

This episode takes listeners behind the scenes of the 2025 AACE clinical practice guideline on the pharmacologic management of adults with dyslipidemia, focusing on the adoption of the GRADE methodology. The panel dissects why AACE transitioned to GRADE, how the guideline was developed, and what clinicians can expect from this new approach. Emphasis is placed on rigor, transparency, patient-centered care, and opportunities for involvement in future guideline development.

Key Discussion Points & Insights

1. Introductions and Backgrounds (00:22–04:14)

• Dr. David Lieb introduces the panel and sets the stage for an in-depth discussion of methodology.
• Dr. Carol Peng shares her journey from new endocrinology fellow to first-ever ACE Methodology Fellow, highlighting her expertise in systematic reviews and meta-analyses.

  “I was very honored to be selected as the first ever Methodology Fellow for the ACE Practice Guideline Task Force… since then I have been leading or co-authored in six meta-analyses and one scoping review project.” (01:23)

• Dr. Shenaz Sultan describes her extensive experience guiding national guideline committees and teaching GRADE.
• Dr. Melanie Bird summarizes her career in guideline development and her excitement for ACE’s inaugural GRADE-based guideline.

2. Understanding the GRADE Framework (04:14–07:34)

• Dr. Sultan provides an overview of GRADE (Grading of Recommendations, Assessment, Development and Evaluation), its international adoption, and its core goal to create a transparent, unified, and patient-focused approach.

  “The framework now is actually considered the standard for guideline development and it’s been adopted by over 200 plus organizations.” (04:29)

• Dr. Bird explains why ACE adopted GRADE:

  • Aligning with global best practices
  • Standardizing processes
  • Updating conflict of interest (COI) and diversity, equity, and inclusion (DEI) policies
  • Enhancing transparency and trustworthiness
  • Joining the GRADE Working Group and Guidelines International Network

  “This is really about providing trustworthy guidance that is patient-centered and facilitates shared decision-making, which is foundational to ACE’s mission.” (07:00)

3. Developing the Guideline: Methodology in Practice (07:34–11:17)

• Dr. Peng details her hands-on experience as Methodology Fellow:

  • Bridging her clinical and methodological backgrounds
  • Fine-tuning PICO (Patient, Intervention, Comparator, Outcome) questions for patient-centeredness
  • Collaborating with librarians for optimal search strategy
  • Managing review of 4,000 abstracts—emphasizing the critical role of systematic review

  “Working with the librarian and the whole team… we can work together and go through the screening process—it’s the very critical stage of the guideline development.” (10:41)

4. GRADE’s Distinctives and Its Impact on Guideline Clarity (11:17–15:15)

• Dr. Sultan highlights why GRADE is unique:

  • Moves away from study-design focus toward outcome-centric evaluations
  • Transparency and explicit criteria for evidence assessment and recommendations
  • Emphasis on clinically and patient-important outcomes over surrogate markers
  • Embraces the totality of evidence and explicit trade-off analysis (benefits vs harms)

  “GRADE places a high value on really understanding what are the patient important outcomes for decision making... there's a big emphasis on the totality of evidence.” (12:13)

• Discusses timeliness and potential for rapid/living guidelines, and how AI could speed up literature synthesis in the future

5. Assessing Evidence Using GRADE (15:15–25:53)

• Dr. Bird offers a detailed walk-through of GRADE’s evidence rating process:

  • Critical domains: study design, risk of bias, consistency, directness, precision, and publication bias
  • Focus on individually weighted, patient-important outcomes (e.g., stroke, mortality), rather than composite endpoints
  • Avoids disease-oriented metrics (e.g., LDL cholesterol) in favor of what truly matters to patients
  • Explains why recommendations may shift from strong to conditional based on the certainty and clinical importance of evidence

  “For most patients, they’re more concerned about whether or not they'll have a heart attack over maybe what their LDL cholesterol level is... We're really taking a lot of care to break that down and to really weigh the different benefits and harms for each step.” (17:50)

6. Evidence to Decision (EtD) Framework (25:53–30:29)

• Dr. Peng and Dr. Sultan explain how GRADE’s EtD framework goes beyond evidence certainty:

  • Incorporates cost, feasibility, accessibility, acceptability, patient preference, and equity
  • Rationales for recommendations are explicit and transparent
  • Ensures stakeholders can understand why a recommendation was made
  • Highlights explicit consideration of potential equity impacts

  “We should not just base everything on clinical data or numbers… clinicians practice in different areas with different resources and not everyone can access the medication or the test…” (27:00) “Are we going to further inequities or… how will we make sure that every patient has the opportunity to actually benefit?” – Dr. Sultan, (29:30)

7. GRADE Recommendations: What Clinicians Need to Know in Practice (30:29–34:00)

• Dr. Sultan on the practical take-home for clinicians:
  • Strong vs. conditional recommendations (“just do it” vs. careful shared decision-making)
  • GRADE facilitates more explicit shared decision-making conversations with patients, using absolute numbers and clear trade-offs

  “Conditional recommendations… really encourages that shared decision making approach, highlighting benefits and downsides, and then coming to a decision that aligns with what the patient really wishes to do.” (32:13)

8. Getting Involved & Methodology Fellow Program (34:00–41:26)

• Dr. Bird details how ACE members can participate:

  • Open calls for task force members and Methodology Fellows—anyone can apply
  • Transparency and inclusiveness: multidisciplinary task forces, patient representation (including partnerships with groups like Women Heart), and review of recommendations for clarity and relevance

  “When organizations make guidelines, they want them adopted widely. But to do that you have to have people at the table, right?” (36:38)

• Dr. Peng encourages fellows and early career professionals:

  • Application process is straightforward and open
  • Valuable opportunity for training, networking, and career growth

Notable Quotes & Memorable Moments

• Dr. Sultan (on what’s changed in her practice):

  “Now I actually utilize a lot of that evidence that we have to develop the recommendation directly with my encounters with my patients.” (33:31)

• Dr. Bird (on transparency):

  “The way ACE is doing it now is extremely transparent, which increases trustworthiness. You can actually look at all the judgments the task force made, that discussion, and you can really understand why the recommendation is the way it is.” (35:15)

• Dr. Peng (encouraging future Methodology Fellows):

  “It probably didn’t take me more than 30 minutes to do the submission process. So it’s like a low hanging fruit for the fellow to get more experience if they are interested in becoming the Methodology Fellow.” (40:57)

Timestamps for Important Segments

• Introductions & Context: 00:22–04:14
• GRADE Framework Overview: 04:14–07:34
• Guideline Methodology and Teamwork: 07:34–11:17
• GRADE’s Unique Approach: 11:17–15:15
• GRADE Evidence Assessment: 15:15–25:53
• Evidence-to-Decision (EtD) Framework: 25:53–30:29
• GRADE in Clinical Practice: 30:29–34:00
• Getting Involved with AACE Guidelines: 34:00–41:26

Conclusion

This episode delivered an in-depth, accessible look at how AACE’s 2025 dyslipidemia guideline was developed using the GRADE methodology—a first for the organization. Listeners gain clarity on why GRADE was chosen, how it enhances rigor, transparency, and patient-centeredness, and are encouraged to participate in future guideline work. The discussion models shared decision-making for clinicians and spotlights opportunities for early career involvement.

For the full guideline and more episodes:
Visit pro.aace.com/ClinicalGuidance and aace.com/podcasts.