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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Article Info
Publication History
Accepted:
November 29,
2012
Received:
November 21,
2012
Footnotes
A summary of recommendations for this article is available in the Supplementary Material.
The disclosure information of the authors and reviewers is available from the CCS on the following websites: www.ccs.ca and/or www.ccsguidelineprograms.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.
Identification
Copyright
© 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Problems With Modified Framingham Risk ScoreCanadian Journal of CardiologyVol. 30Issue 2
- PreviewThe “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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