Advertisement
Canadian Journal of Cardiology

2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult – 2009 recommendations

      This paper is only available as a PDF. To read, Please Download here.
      The present article represents the 2009 update of the Canadian Cardiovascular Society guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult.
      Le présent article contient la mise à jour 2009 des lignes directrices de la Société canadienne de cardiologie pour le diagnostic et le traitement de la dyslipidémie et pour la prévention des maladies cardiovasculaires chez l’adulte.

      Keywords

      References

      1. Heart and Stroke Foundation of Canada. The Growing Burden of Heart Disease and Stroke in Canada 2003. <http://www.cvdinfobase.ca/cvdbook/En/Index.htm>(Version current at August 13, 2009).

      2. Statistics Canada. CANSIM. <http://cansim2.statcan.ca>(Version current at August 13, 2009).

        • McPherson R.
        • Frohlich J.
        • Fodor G.
        • Genest J.
        Canadian Cardiovascular Society. Canadian Cardiovascular Society position statement – recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease.
        Can J Cardiol. 2006; 22: 913-927
        • Ridker P.M.
        • Rifai N.
        • Cook N.R.
        • Bradwin G.
        • Buring J.E.
        Non-HDL cholesterol, apolipoproteins A-I and B-100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women.
        JAMA. 2005; 294: 326-333
        • Ridker P.M.
        • Danielson E.
        • Fonseca F.A.
        • et al.
        • JUPITER Study Group
        Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein.
        N Engl J Med. 2008; 359: 2195-2207
        • Lloyd-Jones D.M.
        • Nam B.H.
        • D’Agostino R.B.
        • et al.
        Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adults – a prospective study of parents and offspring.
        JAMA. 2004; 291: 2204-2211
        • Friedlander Y.
        • Siscovick D.S.
        • Weinmann S.
        • et al.
        Family history as a risk factor for primary cardiac arrest.
        Circulation. 1998; 97: 155-160
        • Després J.P.
        • Lemieux I.
        Abdominal obesity and metabolic syndrome.
        Nature. 2006; 444: 881-887
        • Katzmarzyk P.T.
        • Mason C.
        Prevalence of class I, II and III obesity in Canada.
        CMAJ. 2006; 174: 156-157
        • Alberti K.G.
        • Zimmet P.
        • Shaw J.
        • IDF Epidemiology Task Force Consensus Group
        The metabolic syndrome – a new worldwide definition.
        Lancet. 2005; 366: 1059-1062
        • Ward M.M.
        Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus.
        Arthritis Rheum. 1999; 42: 338-346
        • Gladman D.D.
        • Ang M.
        • Su L.
        • Tom B.D.
        • Schentag C.T.
        • Farewell V.T.
        Cardiovascular morbidity in psoriatic arthritis.
        Ann Rheum Dis. 2009; 68: 1131-1135
        • Thorburn C.M.
        • Ward M.M.
        Hospitalizations for coronary artery disease among patients with systemic lupus erythematosus.
        Arthritis Rheum. 2003; 48: 2519-2523
        • Dorn S.D.
        • Sandler R.S.
        Inflammatory bowel disease is not a risk factor for cardiovascular disease mortality: Results from a systematic review and meta-analysis.
        Am J Gastroenterol. 2007; 102: 662-667
        • Bernstein C.N.
        • Wajda A.
        • Blanchard J.F.
        The incidence of arterial thromboembolic diseases in inflammatory bowel disease: A population-based study.
        Clin Gastroenterol Hepatol. 2008; 6: 41-45
        • Friis-Møller N.
        • Reiss P.
        • Sabin C.A.
        • et al.
        • DAD Study Group
        Class of antiretroviral drugs and the risk of myocardial infarction.
        N Engl J Med. 2007; 356: 1723-1735
        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • et al.
        Efficacy and safety of cholesterol-lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins.
        Lancet. 2005; 366: 1267-1278
      3. The SEARCH Study. <http://www.ctsu.ox.ac.uk/∼search/>(Version current at August 13, 2009).

        • Fruchart J.C.
        • Sacks F.
        • Hermans M.P.
        • et al.
        The residual risk reduction initiative: A call to action to reduce residual vascular risk in patients with dyslipidemia.
        Am J Cardiol. 2008; 102: 1K-34K
        • Johnson C.
        • Waters D.D.
        • DeMicco D.A.
        • et al.
        Comparison of effectiveness of atorvastatin 10 mg versus 80 mg in reducing major cardiovascular events and repeat revascularization in patients with previous percutaneous coronary intervention (post hoc analysis of the Treating to New Targets [TNT] Study).
        Am J Cardiol. 2008; 102: 1312-1317
        • Ford E.S.
        • Ajani U.A.
        • Croft J.B.
        • et al.
        Explaining the decrease in U.S. deaths from coronary disease, 1980–2000.
        N Engl J Med. 2007; 356: 2388-2398
        • Lonn E.
        • Yusuf S.
        • Arnold M.J.
        • et al.
        • Heart Outcomes Prevention Evaluation (HOPE) 2 Investigators
        Homocysteine lowering with folic acid and B vitamins in vascular disease.
        N Engl J Med. 2006; 354: 1567-1577
        • Smith Jr., S.C.
        • Allen J.
        • Blair S.N.
        • et al.
        AHA/ACC; National Heart, Lung, and Blood Institute. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: Endorsed by the National Heart, Lung, and Blood Institute.
        Circulation. 2006; 113: 2363-2372
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • et al.
        • INTERHEART Study Investigators
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study.
        Lancet. 2004; 364: 937-952
        • Go A.S.
        • Chertow G.M.
        • Fan D.J.
        • McCulloch C.E.
        • Hsu C.Y.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Sarnak M.J.
        • Levey A.S.
        • Schoolwerth A.C.
        • et al.
        Kidney disease as a risk factor for development of cardiovascular disease – a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention.
        Circulation. 2003; 108: 2154-2169
        • Barbaro G.
        • Iacobellis G.
        Metabolic syndrome associated with HIV and highly active antiretroviral therapy.
        Curr Diab Rep. 2009; 9: 37-42
        • Galassi A.
        • Reynolds K.
        • He J.
        Metabolic syndrome and risk of cardiovascular disease: A meta-analysis.
        Am J Med. 2006; 119: 812-819
        • Ridker P.M.
        • Buring J.E.
        • Cook N.R.
        • Rifai N.
        C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events.
        Circulation. 2003; 107: 391-397
        • Danesh J.
        • Collins R.
        • Peto R.
        Lipoprotein(a) and coronary heart disease – meta-analysis of prospective studies.
        Circulation. 2000; 102: 1082-1085
        • Davidson M.H.
        • Corson M.A.
        • Alberts M.J.
        • et al.
        Consensus panel recommendation for incorporating lipoprotein associated phospholipase A2 testing into cardiovascular disease risk assessment guidelines.
        Am J Cardiol. 2008; 101: 51F-57F
        • Myers G.L.
        • Christenson R.H.
        • Cushman M.
        • et al.
        • NACB LMPG Committee Members
        National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Emerging biomarkers for primary prevention of cardiovascular disease.
        Clin Chem. 2009; 55: 378-384
        • D’Agostino R.B.
        • Ramachandran S.V.
        • Pencina M.J.
        • et al.
        General cardiovascular risk profile for use in primary care. The Framingham Heart Study.
        Circ. 2008; 117: 743-753
        • Grover S.A.
        • Lowensteyn I.
        • Joseph L.
        • et al.
        • Cardiovascular Health Evaluation to Improve Compliance and Knowledge Among Uninformed Patients (CHECK-UP) Study Group
        Patient knowledge of coronary risk profile improves the effectiveness of dyslipidemia therapy: The CHECK-UP study: A randomized controlled trial.
        Arch Intern Med. 2007; 167: 2296-2303
        • Ridker P.M.
        • Buring J.E.
        • Rifai N.
        • Cook N.R.
        Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: The Reynolds Risk Score.
        JAMA. 2007; 297: 611-619
        • Ridker P.M.
        • Paynter N.P.
        • Rifai N.
        • Gaziano J.M.
        • Cook N.R.
        C-reactive protein and parental history improve global cardiovascular risk prediction: The Reynolds Risk Score for men.
        Circulation. 2008; 118: 2243-2251
        • Michos E.D.
        • Blumenthal R.S.
        • Becker L.C.
        Women with a Framingham risk score < 10 and a family history of premature CHD have a high prevalence of subclinical coronary atherosclerosis.
        Circulation. 2004; 110: 790
        • Lloyd-Jones D.M.
        Short-term versus long-term risk for coronary artery disease: Implications for lipid guidelines.
        Curr Opin Lipidol. 2006; 17: 619-625
        • Graham I.
        • Atar D.
        • Borch-Johnsen K.
        • et al.
        European guidelines on cardiovascular disease prevention in clinical practice: Full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts).
        Eur J Cardiovasc Prev Rehabil. 2007; 14: S1-S113
        • Leiter L.
        • Genest J.
        • Harris S.B.
        • et al.
        Dyslipidemia. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee.
        Can J Diabetes. 2008; 32: S107-S114
        • Downs J.R.
        • Clearfield M.
        • Weis S.
        • et al.
        Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels – results of AFCAPS/TexCAPS.
        JAMA. 1998; 279: 1615-1622
        • Shepherd J.
        • Cobbe S.M.
        • Ford I.
        • et al.
        Prevention of coronary heart-disease with pravastatin in men with hypercholesterolemia.
        N Engl J Med. 1995; 333: 1301-1307
        • Sever P.S.
        • Dahlof B.
        • Poulter N.R.
        • et al.
        Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): A multicentre randomised controlled trial.
        Lancet. 2003; 361: 1149-1158
        • Heart Protection Study Collaborative Group
        MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: A randomised placebo-controlled trial.
        Lancet. 2002; 360: 7-22
        • Anand S.S.
        • Yusuf S.
        • Vuksan V.
        • et al.
        Differences in risk factors, atherosclerosis, and cardiovascular disease between ethnic groups in Canada: The Study of Health Assessment and Risk in Ethnic Groups (SHARE).
        Lancet. 2000; 356: 279-284
        • Kaler S.N.
        • Ralph-Campbell K.
        • Pohar S.
        • King M.
        • Laboucan C.R.
        • Toth E.L.
        High rates of the metabolic syndrome in a First Nations Community in western Canada: Prevalence and determinants in adults and children.
        Int J Circumpolar Health. 2006; 65: 389-402
        • Cannon C.P.
        • Braunwald E.
        • Mccabe C.H.
        • et al.
        Intensive versus moderate lipid lowering with statins after acute coronary syndromes.
        N Engl J Med. 2004; 350: 1495-1504
        • Larosa J.C.
        • Grundy S.M.
        • Waters D.D.
        • et al.
        Intensive lipid lowering with atorvastatin in patients with stable coronary disease.
        N Engl J Med. 2005; 352: 1425-1435
        • Wiviott S.D.
        • de Lemos J.A.
        • Cannon C.P.
        • et al.
        A tale of two trials: A comparison of the post-acute coronary syndrome lipid-lowering trials A to Z and PROVE IT-TIMI 22.
        Circulation. 2006; 113: 1406-1414
        • Pedersen T.R.
        • Faergeman O.
        • Kastelein J.J.P.
        • et al.
        High-dose atorvastatin vs usual-dose simvastatin for secondary prevention after myocardial infarction: The IDEAL study: A randomized controlled trial.
        JAMA. 2005; 294: 2437-2445
        • Murphy S.A.
        • Cannon C.P.
        • Wiviott S.D.
        • et al.
        Effect of intensive lipid-lowering therapy on mortality after acute coronary syndrome (a patient-level analysis of the Aggrastat to Zocor and Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22 trials).
        Am J Cardiol. 2007; 100: 1047-1051
        • Thompson G.R.
        • Hollyer J.
        • Waters D.D.
        Percentage change rather than plasma level of LDL-cholesterol determines therapeutic response in coronary heart disease.
        Curr Opin Lipidol. 1995; 6: 386-388
        • Barter P.J.
        • Ballantyne C.M.
        • Carmena R.
        • et al.
        Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: Report of the Thirty-Person/Ten-Country Panel.
        J Intern Med. 2006; 259: 247-258
        • van der Steeg W.A.
        • Boekholdt S.M.
        • Stein E.A.
        • et al.
        Role of the apolipoprotein B-apolipoprotein A-I ratio in cardiovascular risk assessment: A case-control analysis in EPIC-Norfolk.
        Ann Intern Med. 2007; 146: 640-648
        • Nicholls S.J.
        • Tuzcu E.M.
        • Sipahi I.
        • et al.
        Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis.
        JAMA. 2007; 297: 499-508
        • Kini A.S.
        • Muntner P.
        • Moreno P.R.
        • et al.
        Relation of high-density lipoprotein cholesterol to mortality after percutaneous coronary interventions in patients with low-density lipoprotein <70 mg/dl.
        Am J Cardiol. 2009; 103: 350-354
        • Ridker P.M.
        • Danielson E.
        • Fonseca F.A.
        • et al.
        • on behalf of the JUPITER Trial Study Group
        Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: A prospective study of the JUPITER trial.
        Lancet. 2009; 373: 1175-1182
        • Kjekshus J.
        • Apetrei E.
        • Barrios V.
        • et al.
        • CORONA Group
        Rosuvastatin in older patients with systolic heart failure.
        N Engl J Med. 2007; 357: 2248-2261
        • Tavazzi L.
        • Maggioni A.P.
        • Marchioli R.
        • et al.
        • Gissi-HF Investigators
        Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): A randomised, double-blind, placebo-controlled trial.
        Lancet. 2008; 372: 1231-1239
        • Wanner C.
        • Krane V.
        • März W.
        • et al.
        • German Diabetes and Dialysis Study Investigators
        Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis.
        N Engl J Med. 2005; 353: 238-248
        • Fellström B.C.
        • Jardine A.G.
        • Schmieder R.E.
        • et al.
        • AURORA Study Group
        Rosuvastatin and cardiovascular events in patients undergoing hemodialysis.
        N Engl J Med. 2009; 360: 1395-1407
        • Fowkes F.G.
        • Murray G.D.
        • Butcher I.
        • et al.
        • Ankle Brachial Index Collaboration
        Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: A meta-analysis.
        JAMA. 2008; 300: 197-208
        • Greenland P.
        • Gaziano J.M.
        Clinical practice. Selecting asymptomatic patients for coronary computed tomography or electrocardiographic exercise testing.
        N Engl J Med. 2003; 349: 465-473
        • Stein J.H.
        • Korcarz C.E.
        • Hurst R.T.
        • et al.
        American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine.
        J Am Soc Echocardiogr. 2008; 21: 93-111
        • Greenland P.
        • Bonow R.O.
        • Brundage B.H.
        • et al.
        ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: A report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography).
        Circulation. 2007; 115: 402-426
        • Miller J.M.
        • Rochitte C.E.
        • Dewey M.
        • et al.
        Diagnostic performance of coronary angiography by 64-row CT.
        N Engl J Med. 2008; 359: 2324-2336
        • Kloner R.A.
        • Rezkalla S.H.
        To drink or not to drink? That is the question.
        Circulation. 2007; 116: 1306-1317
        • Sacks F.M.
        • Bray G.A.
        • Carey V.J.
        • et al.
        Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates.
        N Engl J Med. 2009; 360: 859-873
        • Lichtman J.H.
        • Bigger Jr., J.T.
        • Blumenthal J.A.
        • et al.
        Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association.
        Circulation. 2008; 118: 1768-1775
        • Lespérance F.
        • Frasure-Smith N.
        • Koszycki D.
        • et al.
        • CREATE Investigators
        Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial.
        JAMA. 2007; 297: 367-379
        • Frick M.H.
        • Elo O.
        • Haapa K.
        • et al.
        Helsinki Heart Study: Primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease.
        N Engl J Med. 1987; 317: 1237-1245
        • Rubins H.B.
        • Robins S.J.
        • Collins D.
        • et al.
        Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs High-Density Lipoprotein Cholesterol Intervention Trial Study Group.
        N Engl J Med. 1999; 341: 410-418
        • Keech A.
        • Simes R.J.
        • Barter P.
        • et al.
        Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): Randomised controlled trial.
        Lancet. 2005; 366: 1849-1861
        • Frikke-Schmidt R.
        • Nordestgaard B.G.
        • Stene M.C.
        • et al.
        Association of loss-of-function mutations in the ABCA1 gene with high-density lipoprotein cholesterol levels and risk of ischemic heart disease.
        JAMA. 2008; 299: 2524-2532
        • Alrasadi K.
        • Awan K.
        • Ruel I.
        • et al.
        Comparison of treatment of severe high-density lipoprotein cholesterol deficiency in men with daily atorvastatin (20 mg) versus fenofibrate (200 mg) versus extended-release niacin (2 g).
        Am J Cardiol. 2008; 102: 1341-1347
        • Barter P.J.
        • Caulfield M.
        • Eriksson M.
        • et al.
        • ILLUMINATE Investigators
        Effects of torcetrapib in patients at high risk for coronary events.
        N Engl J Med. 2007; 357: 2109-2122
        • Barter P.
        • Gotto A.M.
        • LaRosa J.C.
        • et al.
        • Treating to New Targets Investigators
        HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events.
        N Engl J Med. 2007; 357: 1301-1310
      4. Brown BG, Zhao XQ. Nicotinic acid, alone and in combinations, for reduction of cardiovascular risk. Am J Cardiol 2008; 101:58B-62B. <http://clinicaltrials.gov/ct/show/NCT00120289>.

      5. ClinicalTrials.gov. <http://clinicaltrials.gov/ct2/results?term=NCT00461630>(Version current at August 13, 2009).