2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Grundy, Scott M.; Stone, Neil J.; Bailey, Alison L.; Beam, Craig; Birtcher, Kim K.; Blumenthal, Roger S.; Braun, Lynne T.; Ferranti, Sarah D. de; Faiella-Tommasino, Joseph; Forman, Daniel E.; Goldberg, Ronald; Heidenreich, Paul A.; Mark, Daniel B.; Jones, Daniel W.; Lloyd‐Jones, Donald M.; Lopez-Pajares, Nuria; Ndumele, Chiadi E; Orringer, Carl E.; Peralta, Carmen A.; Saseen, Joseph J.; Smith, Sidney C.; Sperling, Laurence; Virani, Salim S.; Yeboah, Joseph

doi:10.1161/cir.0000000000000624

Cited by 586 publications

(715 citation statements)

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“…While science has advanced over the intervening years, these guidelines still remain appropriate and relevant. New guidelines on cholesterol management were recently published in the United States . In secondary prevention, high intensity or maximally tolerated statin therapy is recommended with the aim of reducing LDL‐C by at least 50%.…”

Section: Who and How To Treat With Lipid‐modifying Drugsmentioning

confidence: 99%

“…Target LDL‐C is still 1.8 mmol/L, but more aggressive therapy with multiple drugs is recommended in patients at very high CVD risk (eg, history of multiple CVD events or multiple risk factors). In primary prevention, a target for LDL‐C is not explicitly stated, but careful assessment of overall CVD risk is recommended …”

Section: Who and How To Treat With Lipid‐modifying Drugsmentioning

confidence: 99%

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An updated review of lipid‐modifying therapy

Simons

2019

Medical Journal of Australia

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Summary Statin drugs reduce low‐density lipoprotein (LDL)‐cholesterol (LDL‐C) and cardiovascular risk. Ezetimibe may be used to supplement statin therapy, or used alone in cases of statin intolerance. Statin‐associated side effects do occur, especially muscle symptoms and new onset diabetes, but they do not detract from the benefits of statin therapy. Inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) reduce LDL‐C and cardiovascular risk. Evolocumab is subsidised in Australia for patients with familial hypercholesterolaemia when LDL‐C is not adequately controlled with maximum doses of statin or ezetimibe or when statin therapy is contraindicated. Fenofibrate reduces triglycerides and cardiovascular risk in patients with type 2 diabetes when triglycerides are elevated and high‐density lipoprotein (HDL) is low. A role for dietary omega‐3 fatty acids and esters in reducing cardiovascular risk remains controversial. All cases of secondary cardiovascular disease prevention merit intensive lipid therapy, unless a contraindication exists. Lipid therapy is justified in cases of primary prevention when absolute risk is high, especially when lipids are highly elevated or when multiple risk factors are present. Clinical management requires a focus on the predominant lipid disorder present, namely hypercholesterolaemia, hypertriglyceridaemia or combined hyperlipidaemia. There is an ongoing problem of poor long term persistence on lipid therapy, as well as reduced awareness by practitioners of poor risk factor control.

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Section: Who and How To Treat With Lipid‐modifying Drugsmentioning

confidence: 99%

Section: Who and How To Treat With Lipid‐modifying Drugsmentioning

confidence: 99%

An updated review of lipid‐modifying therapy

Simons

2019

Medical Journal of Australia

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“…Many studies have shown that hypertriglyceridaemia plays an important role in the development of premature atherosclerosis . Disturbances in triglyceride (TG) metabolism are characterised by postprandial accumulation of TG‐rich lipoprotein remnants and have been observed in various populations with elevated cardiovascular (CV) risk .…”

Section: Introductionmentioning

confidence: 99%

The influence of gene polymorphisms on postprandial triglyceride response after oral fat tolerance test meal in patients with diabetes mellitus

et al. 2019

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Summary Aims We evaluated the influence of CETP (rs5882 and rs708272), APOE (rs7412, rs429358) and LPL (rs328) gene polymorphisms on triglyceride (TG) response to oral fat tolerance test (OFTT) meal in patients with well‐controlled type 2 diabetes mellitus (T2DM). Methods Fifty‐one men underwent OFTT and according to postprandial TG response patients were divided into two subgroups (positive [TG ≥ 220 mg/dL, 31 patients] and negative [TG < 220 mg/dL, 20 patients]). All patients were genotyped, and study variants were detected using polymerase chain reaction (PCR) and restricted fragment length polymorphism (RFLP) analysis. Results Patients with genotype SS of LPL gene compared with genotype SX had more frequently positive response to OFTT (P = .04) and lower high‐density lipoprotein cholesterol (HDL‐C) concentration (P = .03). Patients with positive response to OFTT and genotype SS of LPL gene compared with genotype SX had lower AUC (area under the curve)‐TG, 1744 (368) vs 1887 (807) mg/dL/h, respectively, P = .04. CETP and APOE gene polymorphisms had no influence on postprandial TG response to OFTT. Conclusions In patients with well‐controlled T2DM, LPL but not CETP and APOE gene polymorphisms influenced TG postprandial response. Particularly, S447 allele carriers of LPL gene presented more frequently positive postprandial TG response to OFTT compared with 447X allele carriers. No differences were found between allele carriers of patients with negative response to OFTT in any other studied gene polymorphism.

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“…While we acknowledge that the trials comparing statin dose do not show a significant reduction in coronary heart disease mortality, a meta‐analysis of the trials of high intensity therapy does result in a 15% reduction in myocardial infarction, a 19% reduction in coronary revascularisation, and a 14% reduction in stroke at 12‐month follow‐up compared with conventional dosage . The 2018 United States guidelines for the management of blood cholesterol, which supersede those cited by Dimmitt and Martin, describe this benefit, and recommend initiation of high intensity statin therapy in patients following an acute coronary syndrome. Our study suggests an important advantage of early initiation is to maximise the likelihood that these patients remain on this therapy in the long term.…”

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confidence: 99%