Overview of guidelines for the management of dyslipidemia: EU perspectives

Abstract

Modern medicine is characterized by a continuous genesis of evidence making it very difficult to translate the latest findings into a better clinical practice. Clinical practice guidelines (CPG) emerge to provide clinicians evidence-based recommendations for their daily clinical practice. However, the high number of existing CPG as well as the usual differences in the given recommendations usually increases the clinician’s confusion and doubts. It has apparently been the case for the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol. These CPG proposed new and controversial concepts that have usually been considered an antagonist shift respective to European CPG. The most controversial published proposals are: 1) to consider evidence just from randomized clinical trials, 2) creation of a new cardiovascular (CV) risk calculator, 3) to consider reducing CV risk instead of reducing low-density lipoprotein cholesterol (LDLc) as the target of the treatment, and 4) consideration of statins as the only drugs for treatment. A deep analysis of the 2013 American College of Cardiology/American Heart Association CPG and comparison with the European ones show that from a practical and clinical point of view, there are more similarities than differences. To further help clinicians in their daily work, in the present globalized world, it is time to discuss and adopt a mutually agreed upon document created by both sides of the Atlantic. Probably it is not a short-term solution. Meanwhile, taking advantage of the similarities, the recommended practical attitude for the daily clinical practice should be based on 1) early detection of people with increased CV risk promoting the use of validated local scales, 2) reinforce the mainstream importance of nonpharmacological treatment, and 3) need for periodically monitoring response with analytical parameters (LDL or non-high-density lipoprotein cholesterol) and global CV risk estimation. Technological solutions such as the big data technology could help to obtain high-quality evidence in an intermediate term.

Identifying potentially common genes between dyslipidemia and osteoporosis using novel analytical approaches

“…Dyslipidemia (DL) is a condition with abnormal levels of plasma lipid (PL), including abnormally elevated levels of triglyceride (TG), total cholesterol (TC) and low density lipoprotein cholesterol (LDL), and descended levels of high density lipoprotein cholesterol (HDL) (Giner-Galvan et al 2016). Presence of DL increases the risk of suffering coronary heart disease (CHD) and future cardiovascular (CV) diseases (Fox et al 2016), which are ranked as the top two causes of premature death and decreased disability-adjusted life-years (DALYs) worldwide (Murray et al 2015).…”

Expert opinion on the applicability of dyslipidemia guidelines in Asia and the Middle East

“… 40 By contrast, both the ESC/EAS and the National Institute for Health and Care Excellence (NICE) in the UK have published guidelines that consider sources of data other than RCTs as a valid way of translating evidence to clinical practice. 41 – 44 The International Atherosclerosis Society (IAS) similarly adopts a broader view of evidence in order to make recommendations other than those pertaining to pharmacotherapy and to answer critical questions in clinical intervention. 41 , 45 Rather than focusing on these differences, it is helpful to acknowledge that a divergent methodological approach to evidence likely explains a major part of the dissimilarities between 2013 ACC/AHA guidelines and other clinical practice guidelines, but overall there are only minor points of disagreement.…”

“… 41 – 44 The International Atherosclerosis Society (IAS) similarly adopts a broader view of evidence in order to make recommendations other than those pertaining to pharmacotherapy and to answer critical questions in clinical intervention. 41 , 45 Rather than focusing on these differences, it is helpful to acknowledge that a divergent methodological approach to evidence likely explains a major part of the dissimilarities between 2013 ACC/AHA guidelines and other clinical practice guidelines, but overall there are only minor points of disagreement. In brief, these differences can be summarized in terms of cardiovascular risk algorithm, identification of LDL-C target levels and emphasis on the use of non-statin drugs, as well as lifestyle intervention.…”