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Copyright © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. All rights reserved., © 2020 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espa ̃na, S.L.U. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)., Introduction and objectives: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. Methods: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. Results: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). Conclusions: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

Introduction and Aims: Atherogenic dyslipidemia is an important contributor to residual cardiovascular (CV) risk, but it is underdiagnosed and undertreated. This study aimed to assess the opinion of Portuguese experts to generate a consensus concerning the diagnosis and treatment of atherogenic dyslipidemia, as well as to contribute toward standardization of clinical practice in this disorder. Methods: The study consisted in the application of a questionnaire to an expert panel, following a modified Delphi methodology. Results: The majority (88.4%) of the proposed items were found to be consensual. The expert panel recognized the importance of the atherogenic dyslipidemia phenotype, the role played by low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol as risk markers and therapeutic targets, the choice of statins as first-line lipid-lowering drugs, and the value of associating statins with fenofibrate as a means to reduce residual CV risk. However, the role played by triglycerides in CV risk and the therapeutic value of fibrates lacked consensus. Taking into consideration the state of the art and the opinions expressed in this study, the scientific committee developed a treatment algorithm aimed to improve the perception and treatment of atherogenic dyslipidemia. Conclusions: The experts involved in this study were shown to be familiar with the concept and the importance of atherogenic dyslipidemia. The few situations in which a consensus could not be found were mainly related to the interpretation and/or relevance of the available evidence. Resumo: Introdução e objetivos: A dislipidemia aterogénica contribui consideravelmente para o risco residual de doença cardiovascular (DCV); não obstante, esta patologia encontra-se subdiagnosticada e submedicada. O objetivo deste estudo foi analisar a opinião dos especialistas portugueses e gerar um consenso sobre o diagnóstico e o tratamento da dislipidemia aterogénica, bem como promover a uniformização da prática clínica neste contexto. Métodos: Este estudo consistiu na aplicação de um questionário a um painel de peritos seguindo uma metodologia Delphi modificada. Resultados: A maioria dos itens (88,4%) foram consensuais. Os peritos inquiridos mostraram reconhecer a importância da dislipidemia aterogénica, o papel preponderante do colesterol de lipoproteínas de baixa densidade (c-LDL) e do colesterol total excluindo o das lipoproteínas de alta densidade (colesterol não HDL) na indicação do risco cardiovascular e na definição de objetivos terapêuticos, a eleição das estatinas como fármaco antidislipidémico de primeira linha, e a pertinência da sua associação com o fenofibrato para a redução do risco residual. Não obstante, o painel manifestou incerteza no que se refere ao papel dos triglicerídeos e ao valor terapêutico dos fibratos. Tendo como base a evidência disponível na literatura e as opiniões recolhidas neste estudo, a comissão científica elaborou um algoritmo de tratamento com o objetivo de promover a sensibilização e adequação da terapêutica a doentes com dislipidemia aterogénica. Conclusões: Os inquiridos mostraram estar familiarizados com o conceito e com a importância da dislipidemia aterogénica; as poucas situações de ausência de consenso poderão estar relacionadas com uma diferente interpretação e/ou valorização da evidência científica disponível. Keywords: Atherogenic dyslipidemia, Low-density lipoprotein cholesterol, Non-high-density lipoprotein cholesterol, Triglycerides, Fenofibrate, Residual cardiovascular risk, Palavras-chave: Dislipidemiaaterogénica, c-LDL, Colesterol não-HDL, Triglicerídeos, Fenofibrato, Risco cardiovascularresidual