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Dyslipidaemias 2016 (Management of)

ESC Clinical Practice Guidelines

The present Guidelines represent an evidence-based consensus, by appraising the current evidence and indentifying remaining knowledge gaps in managing the prevention of dyslipIdaemias,  the Task Force formalated recommendations to guide actions to prevent CVD in clinical practice by controlling elevated lipid plasma levels.

Primary care
Hypertension
Dyslipidemia
Guidelines version available to download
Published in 2016
Reference 10.1093/eurheartj/ehw272 - European Heart Journal 2016
Published in 2016
Reference Table of Contents
PDA
Published in 2016
Reference Download the Pocket Guidelines App
Published in 2016
Reference Essential Messages Dyslipidaemias
Published in 2012
Reference Slide-set on Dyslipidaemias
Published in 2011
Reference ESC/EAS CME Questions Dyslipidaemias
Published in 2011
Reference European Heart Journal (2011) 32:1769-1818
Published in 2011
Reference ESC/EAS Dyslipidemias addenda
Table of contents: Full Text (ESC Clinical Practice Guidelines)

List of abbreviations

Preamble

What is cardiovascular disease prevention?

  • Definition and rationale
  • Development of the Joint Task Force guidelines
  • Cost-effectiveness of prevention

Total cardiovascular risk

  • Total cardiovascular risk estimation          
    • Rationale for assessing total cardiovascular disease risk
    • How to use the risk estimation charts
  •  Risk levels
    • Risk based intervention strategies

Evaluation of laboratory lipid and apolipoprotein parameters

  • Fasting or non-fasting?
  • Intra-individual variation
  • Lipid and lipoprotein analyses
    • Total cholesterol
    • Low-density lipoprotein-cholesterol
    • Non-high-density lipoprotein-cholesterol
    • High-density lipoprotein-cholesterol
    • Triglycerides
    •  Apolipoproteins
    • Lipoprotein(a)
    • Lipoprotein particle size
    •  Genotyping

Treatment targets

Lifestyle modifications to improve the plasma lipid profile

  • The influence of lifestyle on total cholesterol and low-density lipoprotein-cholesterol levels
  • The influence of lifestyle on triglyceride levels
  • The influence of lifestyle on high-density lipoprotein-cholesterol levels
  • Lifestyle recommendations to improve the plasma lipid profile
    •  Body weight and physical activity
    • Dietary fat
    • Dietary carbohydrate and fibre
    • Alcohol
    • Smoking
  • Dietary supplements and functional foods for the treatment of dyslipidaemias
    • Phytosterols
    • Monacolin and red yeast rice
    • Dietary fibre
    • Soy protein
    • Policosanol and berberine          
    • n-3 unsaturated fatty acids
  •  Other features of a healthy diet contributing to cardiovascular disease prevention

Drugs for treatment of hypercholesterolaemia

  • Statins
    • Mechanism of action
    • Efficacy of cardiovascular disease prevention in clinical studies
    • Adverse effects of statins
    • Interactions
  • Bile acid sequestrants
    • Mechanism of action
    • Efficacy in clinical studies          
    • Adverse effects and interactions
  • Cholesterol absorption inhibitors
    • Mechanism of action
    • Efficacy in clinical studies          
    • Adverse effects and interactions
  • PCSK9 inhibitors
    • Mechanism of action
    • Efficacy in clinical studies
    • Adverse effects and interactions
  • Nicotinic acid
  • Drug combinations
    • Statins and cholesterol absorption inhibitors
    • Statins and bile acid sequestrants         
    • Other combinations

Drugs for treatment of hypertriglyceridaemia

  • Triglycerides and cardiovascular disease risk
  • Definition of hypertriglyceridaemia
  • Strategies to control plasma triglycerides
  • Statins
  • Fibrates
    • Mechanism of action
    • Efficacy in clinical trials
    • Adverse effects and interactions
  • Nicotinic acid
    • Mechanism of action
    • Efficacy in clinical trials
  • n-3 fatty acids
    • Mechanism of action
    • Efficacy in clinical trials
    • Safety and interactions

Drugs affecting high-density lipoprotein-cholesterol (Table 20)

  • Statins
  • Fibrates
  • Nicotinic acid
  • Cholesteryl ester transfer protein inhibitors          
  • Future perspectives          

Management of dyslipidaemia in different clinical settings

  • Familial dyslipidaemias
    • Familial combined hyperlipidaemia
    • Familial hypercholesterolaemia
    • Familial dysbetalipoproteinaemia
    • Genetic causes of hypertriglyceridaemia
    • Other genetic disorders of lipoprotein metabolism (Table 23)
  • Children
  • Women
    • Primary prevention
    • Secondary prevention
    • Non-statin lipid-lowering drugs
    • Hormone therapy           
  • Older persons
    • Primary prevention
    • Secondary prevention
    • Adverse effects, interactions and adherence
  • Diabetes and metabolic syndrome
    • Specific features of dyslipidaemia in insulin resistance and type 2 diabetes (Table 25)
    • Evidence for lipid-lowering therapy
    • Treatment strategies for subjects with type 2 diabetes and metabolic syndrome
    • Type 1 diabetes
  • Patients with acute coronary syndrome and patients undergoing percutaneous coronary intervention
    • Specific lipid management issues in acute coronary syndrome
    • Lipid management issues in patients undergoing percutaneous coronary intervention
  • Heart failure and valvular diseases
    • Prevention of incident heart failure in coronary artery disease patients
    • Chronic heart failure
    • Valvular disease
  • Autoimmune diseases
  • Chronic kidney disease
    • Lipoprotein profile in chronic kidney disease
    • Evidence for lipid management in patients with chronic kidney disease
    • Safety of lipid management in patients with chronic kidney disease
    • Recommendations of lipid management for patients with chronic kidney disease
  • Transplantation (Table 31)
  • Peripheral arterial disease           
    • Lower extremities arterial disease
    • Carotid artery disease
    • Retinal vascular disease
    • Secondary prevention in patients with aortic abdominal aneurysm
    • Renovascular atherosclerosis
  • Stroke
    • Primary prevention of stroke
    • Secondary prevention of stroke
  • Human immunodeficiency virus patients
  • Mental disorders

Monitoring of lipids and enzymes in patients on lipid-lowering therapy (Table 36)

Strategies to encourage adoption of healthy lifestyle changes and adherence to lipid modifying therapies

  • Achieving and adhering to healthy lifestyle changes
  • Adhering to medications

To do and not to do messages from the Guidelines

Appendix

References

 


 

 

 

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