Waiting for the National Cholesterol Education Program Adult Treatment Panel IV Guidelines, and in the Meantime, Some Challenges and Recommendations
ABSTRACT The National Cholesterol Education Program Adult Treatment Panel (ATP) has provided education and guidance for decades on the management of hypercholesterolemia. Its third report (ATP III) was published 10 years ago, with a white paper update in 2004. There is a need for translation of more recent evidence into a revised guideline. To help address the significant challenges facing the ATP IV writing group, this statement aims to provide balanced recommendations that build on ATP III. The authors aim for simplicity to increase the likelihood of implementation in clinical practice. To move from ATP III to ATP IV, the authors recommend the following: (1) assess risk more accurately, (2) simplify the starting algorithm, (3) prioritize statin therapy, (4) relax the follow-up interval for repeat lipid testing, (5) designate <70 mg/dl as an "ideal" low-density lipoprotein cholesterol target, (6) endorse targets beyond low-density lipoprotein cholesterol, (7) refine therapeutic target levels to the equivalent population percentile, (8) remove misleading descriptors such as "borderline high," and (9) make lifestyle messages simpler. In conclusion, the solutions offered in this statement represent ways to translate the totality of published reports into enhanced hyperlipidemia guidelines to better combat the devastating impact of hyperlipidemia on cardiovascular health.
SourceAvailable from: Michael J BlahaJournal of the American Heart Association 09/2014; 3(5). DOI:10.1161/JAHA.114.001098
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ABSTRACT: High density lipoproteins (HDL) have been addressed as a potential strategy for cardiovascular prevention, with great controversies on pharmacological approaches for HDL-elevation. Aim to compare HDL-rising treatment with niacin or CETP-inhibitors with optimal medical therapy in cardiovascular outcome. Methods Randomized trials were searched. Primary endpoint was cardiovascular death, secondary were: non fatal myocardial infarction; coronary revascularization; cerebrovascular accidents and safety endopoints. Results 18 randomized trials, 69515 patients, were included. HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR[95%CI]=0.96[0.87-1.05], p=0.37,phet=0.58), with no benefit from niacin/CETP inhibitors according to patients’ risk profile (beta[95%CI]=-0.14[-0.29-0.02],p=0.09) or the amount of HDL increase (beta[95%CI]=0.014[-0.008-0.04],p=0.21). Niacin but not CETP reduced myocardial infarction and coronary revascularization, but higher rate of SAE occurred with HDL-modifiers (OR[95%CI]=1.24[1.18-1.31],p<0.00001,phet=0.02), in particular new onset of diabetes with niacin and worsening of hypertension with CETP-inhibitors. Conclusions Niacin and CETP inhibitors do not influence cardiovascular mortality. Significant benefits in MI and coronary revascularization were observed with niacin, despite the higher occurrence of diabetes.Nutrition Metabolism and Cardiovascular Diseases 09/2014; 25(1). DOI:10.1016/j.numecd.2014.09.003 · 3.88 Impact Factor
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ABSTRACT: Following a myocardial infarction, lipid-lowering therapy is an established intervention to reduce the risk of recurrent cardiovascular events. Prior studies show a need to improve clinical practice in this area. Here, we review the latest research and perspectives on improving postmyocardial infarction lipid control.Current Opinion in Cardiology 07/2014; DOI:10.1097/HCO.0000000000000093 · 2.59 Impact Factor