Canadian Journal of Cardiology

2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult

      Abstract

      Many developments have occurred since the publication of the widely-used 2009 Canadian Cardiovascular Society (CCS) Dyslipidemia guidelines. Here, we present an updated version of the guidelines, incorporating new recommendations based on recent findings and harmonizing CCS guidelines with those from other Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used, per present standards of the CCS. The total cardiovascular disease Framingham Risk Score (FRS), modified for a family history of premature coronary disease, is recommended for risk assessment. Low-density lipoprotein cholesterol remains the primary target of therapy. However, non-high density lipoprotein cholesterol has been added to apolipoprotein B as an alternate target. There is an increased emphasis on treatment of higher risk patients, including those with chronic kidney disease and high risk hypertension. The primary panel has recommended a judicious use of secondary testing for subjects in whom the need for statin therapy is unclear. Expanded information on health behaviours is presented and is the backbone of risk reduction in all subjects. Finally, a systematic approach to statin intolerance is advocated to maximize appropriate use of lipid-lowering therapy. This document presents the recommendations and principal conclusions of this process. Along with associated Supplementary Material that can be accessed online, this document will be part of a program of knowledge translation. The goal is to increase the appropriate use of evidence-based cardiovascular disease event risk assessment in the management of dyslipidemia as a fundamental means of reducing global risk in the Canadian population.

      Résumé

      De nombreux développements sont survenus depuis la publication communément utilisée des Lignes directrices 2009 de la Société canadienne de cardiologie (SCC) sur la dyslipidémie. Nous présentons ici une version mise à jour des lignes directrices, qui inclut des nouvelles recommandations fondées sur des résultats récents qui harmonisent les lignes directrices de la SCC à celles d'autres sociétés. La méthode GRADE ( Grading of Recommendations Assessment, Development and Evaluation) a été utilisée selon les normes actuelles de la SCC. Le score de risque cardiovasculaire global de Framingham (SRF) total sur les maladies cardiovasculaires modifié pour tenir compte des antécédents familiaux de coronaropathie prématurée est recommandé pour l'évaluation du risque. Le cholestérol à lipoprotéines de faible densité demeure la cible principale du traitement. Cependant, le cholestérol non à lipoprotéines de haute densité a été ajouté à l'apolipoprotéine B comme autre cible. L'accent est davantage mis sur le traitement des patients exposés à un risque élevé, incluant ceux ayant une maladie rénale chronique et une hypertension à risque élevé. Le panel principal a recommandé une utilisation judicieuse d'examens secondaires des sujets chez qui la nécessité d'un traitement par des statines est incertaine. De plus en plus de renseignements sur les comportements en matière de santé sont présentés et sont les bases de la réduction du risque chez tous les sujets. Finalement, une approche systématique sur l'intolérance aux statines est recommandée pour optimiser l'utilisation de traitements hypolipidémiants. Ce document présente les recommandations et les conclusions principales de ce processus. Par les contenus complémentaires associés qui peuvent être consultés en ligne, ce document fera partie d'un programme d'application des connaissances. Le but est d'accroître l'utilisation appropriée de l'évaluation des risques d'événements cardiovasculaires fondée sur les preuves dans la prise en charge de la dyslipidémie en tant que moyen fondamental pour réduire le risque global dans la population canadienne.
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      Linked Article

      • Problems With Modified Framingham Risk Score
        Canadian Journal of CardiologyVol. 30Issue 2
        • In Brief
          The “2012 Update of the Canadian Cardiovascular Society Guidelines for the Diagnosis and Treatment of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult” introduces a modified Framingham Risk Score, which is the 10-year Framingham risk percent doubled for family history of premature cardiovascular disease (CVD).1 However, clinicians should avoid using this modification for a number of reasons.
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