Canadian Cardiovascular Society position statement – Recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease

Prevalence of dyslipidemia in statin-treated patients in Canada: Results of the DYSlipidemia International Study (DYSIS)

“…Comorbidities were common, including hypertension (75.2%), diabetes mellitus (47.8%) and previous cardiovascular disease (ischemic heart disease, heart failure, peripheral arterial disease or cerebrovascular disease [44.8%]). The majority (80%) of patients fell into the high 10-year risk category (cardiovascular disease, diabetes mellitus or a Framingham risk score of 20% or greater) (2).…”

“…The lipid profile stratified according to Canadian Cardiovascular Society cardiovascular risk category is provided in Table 2. Of note, 37% of all patients did not have an LDL-C at goal (defined as 2.0 mmol/L or greater for high risk) or intervention levels (3.5 mmol/L or greater for intermediate risk, and 5.0 mmol/L or greater for low risk [2]), including 45% of high-risk category patients. Overall, 23.3% of patients had a TC/HDL-C ratio above the guideline-recommended goal (high risk 4 or greater) or intervention levels (intermediate risk 5 or greater, and low risk 6 or greater), including 27.5% of high-risk patients.…”

“…Specific patient-related lipid targets, whether patients were at goal levels, and the relevance of the different lipid parameters for the physicians were also recorded. The 2006 Canadian Cardiovascular Society recommendations were used to classify patient risk, and define the LDL-C and TC/HDL-C goals and intervention targets (2).…”

“…Continuous variables are summarized as medians with 25th and 75th percentiles (interquartile range [IQR]). Multivariable logistic regression analysis was performed to determine the factors in high-risk patients associated with LDL-C values and TC/HDL-C ratios not at goal (less than 2.0 mmol/L and less than 4, respectively) (2). Based on the results of previous studies (4,7), the predictor variables considered in the models were age, sex, current smoker, sedentary lifestyle (physical activity less than the equivalent of walking 20 min to 30 min, three to four days a week), body mass index 30 kg/m 2 or greater, waist circumference greater than 102 cm in men and greater than 88 cm in women, hypertension, diabetes mellitus, history of ischemic heart disease, cerebrovascular disease and peripheral artery disease.…”

The 2006 Canadian dyslipidemia guidelines will prevent more deaths while treating fewer people – but should they be further modified?

“…We previously assessed the 2003 Canadian recommendations from a population perspective (2) and found that they performed worse than those of other countries' recommendations. We now provide an updated assessment for the most recent (2006) changes to the Canadian recommendations (3). A detailed description of our methodology, including the assumptions of our model, can be found in the accompanying Appendixes 1 to 3.…”