Recommendations for the management and treatment of dyslipidemia. Report of the Working Group on Hypercholesterolemia and Other Dyslipidemias

Table 1: Summary of changes in the recommendations for the management of dyslipidemia by the Working Group on Hypercholesterolemia and Other Dyslipidemias[*] - Patients with diabetes mellitus over the age of 30 years are now classified as being at very high risk for CAD - The target LDL-C level for people classified as being at high risk for CAD (10-year calculated risk 20%-30%) has been decreased from 3.5 mmol/L to 3.0 mmol/L - The assessment of risk factors has been simplified - All categorical risk factors should be treated, if possible by nonpharmacological means - For patients at high and very high risk whose lipid concentrations are above target levels, pharmacological treatment should be initiated concomitantly with diet - For patients at low and moderate risk, pharmacological treatment should be initiated if target lipid levels are not met after 3 and 6 months, respectively, of lifestyle therapy Note: CAD = coronary artery disease, LDL-C = low-density-lipoprotein cholesterol. [*] Changes since the committee's interim report, published in April 1998.(f.17) In 1998 Wilson and associates(f.30) published a simple coronary disease prediction algorithm to assist physicians in predicting multivariate CAD risk in patients without overt CAD. This particular prediction model, as well as the recently published global risk assessment scores,(f.18) integrates continuous variables from prior CAD prediction models and categorical approaches, or various treatment guidelines, including the guidelines of the Working Group on Hypercholesterolemia and Other Dyslipidemias. Using these tables, a person's 10-year risk of symptomatic CAD can be estimated and lipid target levels determined (Tables 2 and 3). The calculated risk is based on information in available databases; however certain caveats apply. For instance, the risk prediction is relatively short term (10 years), and many patients at moderate short-term risk are at high long-term risk for CAD).(f.31) The Framingham data do not apply to people with extreme or unusual risk factors such as severe familial hypercholesterolemia or those with very low levels of HDL-C (familial hypoalphalipoproteinemia). The impact of ethnic background and family history on CAD risk also requires further study. Finally, there are many emerging risk factors for CAD such as elevated levels of lipoprotein(a), fibrinogen, C-reactive protein and homocyst(e)ine that are likely to be incorporated into risk-calculation equations in the future.