The new guidelines cover in detail one specific aspect of cardiovascular prevention which is also being developed in a broader ongoing guideline on cardiovascular prevention, which will be published in 2012.
The importance of placing dyslipidaemias in the context of other cardiovascular risk factors is emphasised and the place of lipid profiling in order to assess total cardiovascular risk is discussed. To this end, the guidelines provide a four-stage estimation of global risk - with very high, moderate and low risk groups, which extend the traditional high and low risk groups based on SCORE ≥5% or <5% to a more gradual scale of risk assessment from the dyslipidaemia point of view. HDL-cholesterol also is integrated in the risk assessment.
Treatment targets are discussed and, although LDL-cholesterol remains the key target in most situations, the potential importance of apo B and non-HDL-cholesterol is introduced, as well as the consideration of triglyceride levels.
The importance of lifestyle and diet on dyslipidaemias and how to practically implement lifestyle and dietary changes is reviewed. It is, however, acknowledged that the evidence for any major impact of dietary supplements and functional food products on clinical outcomes has not been shown and that, although diet has an important influence on dyslipidaemias and clinical outcomes, these supplementation products still need to be properly evaluated in clinical trials.
Drugs for treatment of hypercholesterolaemia and hypertriglyceridaemia, as well as drugs affecting HDL-cholesterol and their combinations, are reviewed. A simple algorithm is presented for the optimal use of statins in the treatment of hypercholesterolaemia which gives practical recommendations depending on the extent of target LDL-cholesterol reduction, and the possible choices of various statins and doses expected to reach those target values.
An entire section is devoted to the management of dyslipidaemias in different clinical settings, such as children, women, the elderly, the metabolic syndrome and diabetes, patients with acute coronary syndrome, heart failure, renal disease, autoimmune diseases, peripheral artery disease, stroke, HIV and post-transplantation patients. This section also includes an extensive discussion of familial dyslipidaemias and how to diagnose them.
The guidelines finally give clear and simple recommendations for monitoring lipids and detecting adverse events in patients on lipid-lowering therapy. Addenda to the guidelines, accessible on the ESC website in the guidelines section, give SCORE charts, including HDL-cholesterol, a table and figure of statin doses expected to lower LDL-cholesterol to various levels, a table of inhibitors and inducers of pathways involved in statin metabolism and transport, and references. Throughout the guidelines, references are given to clinical trials and observational studies supporting the evidence for each recommendation.
No doubt these new guidelines will be extremely useful to all physicians, cardiologists and non cardiologists, for the everyday management of patients with dyslipidaemias.