I am proud to announce the completion of a new and important International Atherosclerosis Society (IAS) Position Paper entitled “Global Recommendations for the Management of Dyslipidemia”. This paper has been developed as an aid to the management of the dyslipidemia that is driving a worldwide epidemic of atherosclerotic cardiovascular disease.
The position paper is the result of more than a year of deliberations by a group of international experts led by Scott Grundy. Members of this group are listed at the end of this editorial. These experts were representatives of many different regions of the world. Questions relating to lifestyle and drug management of dyslipidemia were addressed in an iterative process that culminated in a final draft that was provided to the IAS Executive Committee for comment and suggestion. This final draft was also shared with IAS member societies for comment and ratification. Many of our member societies provided valuable feedback with suggestions that were incorporated into the final version of the document.
This IAS Position Paper provides background rationale, panel deliberations, and IAS recommendations. It reviews existing evidence-based recommendations and consolidates them into an overall set of recommendations. These recommendations are meant to inform clinical judgment and not to replace it. The report is divided into primary and secondary prevention. For secondary prevention, priority is given to randomized, controlled clinical trials (RCTs) because of a wealth of data. For primary prevention, RCT evidence is limited and recommendations are based on many years of accumulated research in epidemiology, genetics and basic science in addition to clinical trials.
As stated in the executive summary of the position paper, the major innovations are the following:
International consensus guidelines based on multiple lines of evidence.
Identification of non-HDL-cholesterol (non-HDL-C) as a major form of atherogenic cholesterol.
Definition of atherogenic cholesterol as either LDL-cholesterol (LDL-C) or non-HDL-C.
Definition of optimal levels of atherogenic cholesterol (both LDL-C and non-HDL-C) for primary and secondary prevention.
Assigning priority to long-term risk categories over short-term risk.
Adjustment of risk estimation according to baseline risk of different nations or regions.
Primary emphasis on lifestyle intervention; secondary emphasis on drug therapy.
The current document resembles other guidelines in many respects. One aim of this IAS effort is to harmonize existing guidelines such that they are applicable on a worldwide basis. Moreover it adds a perspective that may not be present in some of the existing guidelines. Because of advances in drug management of dyslipidemia, many guidelines tend to over-emphasize drug therapy at the expense of lifestyle intervention. It is the view of the IAS that, with the exception of genetic dyslipidemias, atherosclerotic disease is largely a disease of unhealthy life habits. An important goal of these new IAS recommendations is to reset the balance between lifestyle intervention and drug treatment.
I would like to stress that this position paper is intended to be a living document that will be updated on a regular basis as new evidence emerges. I would also like to say that it is the first in what will be a series of position papers on a range of topics related to the global prevention of atherosclerotic cardiovascular disease.
Finally, the IAS recognizes that many countries and regions have developed their own dyslipidemia guidelines. For them, this IAS document is available as a resource should they choose to modify their own guidelines. For countries and regions that do not currently have their own guidelines, the IAS document is available as an aid for them to develop their own guidelines (with help from the IAS if needed).
Chair:
Scott M. Grundy – Professor of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Members:
Hidenori Arai – Professor, Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Philip Barter − Director Emeritus, Heart Research Institute, Newtown, Sydney, Australia.
Thomas P. Bersot – Associate Investigator and Professor of Medicine, J. David Gladstone Institutes, University of California San Francisco, San Francisco, California, USA.
John Betteridge – Consultant Physician, University College Hospital London and Emeritus Professor of Endocrinology and Metabolism, University College London, London, UK.
Rafael Carmena – Professor Emeritus of Internal Medicine and Endocrinology, University of Valencia, Spain, General Director of the Clinical Research Institute (INCLIVA), University Hospital, Valencia, Spain.
Ada Cuevas - Department of Nutrition, Clínica Las Condes, Santiago, Chile
Michael H. Davidson – Professor, Director of the Lipid Clinic, The University of Chicago, Pritzker School of Medicine, Chicago, IL, USA.
Jacques Genest – Cardiologist, Professor, Faculty of Medicine, McGill University, Novartis Chair in Medicine at McGill, Scientific Director, Center for Innovative Medicine, McGill University Health Center/Royal Victoria Hospital, 687 Pine avenue West, Montreal, QC, Canada.
Y. Antero Kesäniemi – Professor of Internal Medicine, Emeritus, Institute of Clinical Medicine, Department of Medicine, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland
Shaukat Sadikot – DiabetesIndia, Mumbai, India.
Raul D. Santos – Director Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Associate Professor of Cardiology, University of Sao Paulo, Brazil.
Andrey Susekov – Associate Professor, Laboratory of Clinical Lipidology, Department of Atherosclerosis, Cardiology Research Complex, Moscow, Russia.
Rody Sy – Professor and Chair, Department of Medicine, University of the Philippines - Manila, College of Medicine, Manila, Philippines
Lale Tokgozoglu – Professor of Cardiology, Hacettepe University, Ankara, Turkey.
Gerald F. Watts – Winthrop Professor, Cardiometabolic Medicine, Cardiometabolic Clinic, Royal Perth Hospital, School of Medicine and Pharmacology, The University of Western Australia, Australia.
Dong Zhao – Deputy Director & Professor, Beijing Institute of Heart, Lung & Blood Vessel Diseases, Capital Medical University Beijing Anzhen Hospital, Beijing, China.