1. World Heart Federation Cholesterol Roadmap 2022
- Author
-
Kausik K. Ray, Brian A. Ference, Tania Séverin, Dirk Blom, Stephen J. Nicholls, Mariko H. Shiba, Wael Almahmeed, Rodrigo Alonso, Magdalena Daccord, Marat Ezhov, Rosa Fernández Olmo, Piotr Jankowski, Fernando Lanas, Roopa Mehta, Raman Puri, Nathan D. Wong, David Wood, Dong Zhao, Samuel S. Gidding, Salim S. Virani, Donald Lloyd-Jones, Fausto Pinto, Pablo Perel, Raul D. Santos, [Ray, Kausik K.] Imperial Coll London, Imperial Ctr Cardiovasc Dis Prevent, Dept Primary Care & Publ Hlth, Reynolds Bldg,St Dunstans Rd, London W6 8RP, England, [Ference, Brian A.] British Heart Fdn, Dept Publ Hlth & Primary Care, London, England, [Ference, Brian A.] Univ Cambrige, Ctr Naturally Randomized Trials, Cardiovasc Epidemiol Unit, Cambridge, England, [Severin, Tania] World Heart Federat, Geneva, Switzerland, [Blom, Dirk] Univ Cape Town, Dept Med, Cape Town, South Africa, [Nicholls, Stephen J.] Monash Univ, Victorian Heart Inst, Melbourne, Vic, Australia, [Shiba, Mariko H.] Osaka Med & Pharmaceut Univ, Cardiovasc Ctr, Takatsuki, Osaka, Japan, [Almahmeed, Wael] Cleveland Clin Abu Dhabi, Abu Dhabi, U Arab Emirates, [Alonso, Rodrigo] Ctr Adv Metab Med & Nutr, Santiago, Chile, [Ezhov, Marat] Chazov Natl Med Res Ctr Cardiol, Moscow, Russia, [Olmo, Rosa Fernandez] Jaen Univ Hosp, Cardiac Rehabil Unit, Jean, Spain, [Jankowski, Piotr] Ctr Postgrad Med Educ, Sch Publ Hlth, Dept Internal Med & Geriatr Cardiol, Warsaw, Poland, [Jankowski, Piotr] Ctr Postgrad Med Educ, Sch Publ Hlth, Dept Epidemiol & Hlth Promot, Warsaw, Poland, [Lanas, Fernando] Univ La Frontera, Temuco, Chile, [Mehta, Roopa] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Mexico City, DF, Mexico, [Puri, Raman] Apollo Hosp, Dept Cardiol, New Delhi, India, [Wong, Nathan D.] Univ Calif Irvine, Irvine, CA USA, [Wood, David] Natl Univ Ireland Galway, Hlth, Galway, Ireland, [Zhao, Dong] Capital Med Univ, Beijing Anzhen Hosp, Beijing Inst Heart Lung & Blood Vessel Dis, Beijing, Peoples R China, [Gidding, Samuel S.] Geisinger Genom Med Inst, Danville, PA USA, [Virani, Salim S.] Baylor Coll Med, Michael E DeBakey Vet Affairs Med Ctr, Houston, TX 77030 USA, [Lloyd-Jones, Donald] Northwestern Univ, Prevent Med, Chicago, IL 60611 USA, [Pinto, Fausto] Univ Lisbon, Lisbon Sch Med, Lisbon, Portugal, [Perel, Pablo] London Sch Hyg & Trop Med & World Heart Federat, London, England, [Santos, Raul D.] Univ Sao Paulo, Cardiopneumol Dept & Lipid Clin, Heart Inst InCor, Med Sch Hosp, Sao Paulo, Brazil, and [Santos, Raul D.] Hosp Israelita Albert Einstein, Sao Paulo, Brazil
- Subjects
Epidemiology ,Lipoproteins ,Familial hypercholesterolemia ,low-density lipoprotein cholesterol prevention ,Cardiorespiratory Medicine and Haematology ,Cardiovascular ,Cardiovascular-disease ,lipid lowering therapy ,Clinical Research ,Humans ,Heart Disease - Coronary Heart Disease ,Dyslipidemias ,Apolipoproteins B ,Community and Home Care ,Ldl-cholesterol ,Prevention ,cholesterol ,ASCVD ,familial hypercholesterolaemia ,Individuals ,Metaanalysis ,Health Services ,Atherosclerosis ,Statin therapy ,Evolocumab ,Management ,Risk-factors ,Heart Disease ,Good Health and Well Being ,Cholesterol ,Cardiovascular Diseases ,Patient Safety ,Hydroxymethylglutaryl-CoA Reductase Inhibitors ,Cardiology and Cardiovascular Medicine - Abstract
Background: Atherosclerotic cardiovascular diseases (ASCVD) including myocardial infarction, stroke and peripheral arterial disease continue to be major causes of premature death, disability and healthcare expenditure globally. Preventing the accumulation of cholesterol-containing atherogenic lipoproteins in the vessel wall is central to any healthcare strategy to prevent ASCVD. Advances in current concepts about reducing cumulative exposure to apolipoprotein B (apo B) cholesterol-containing lipoproteins and the emergence of novel therapies provide new opportunities to better prevent ASCVD. The present update of the World Heart Federation Cholesterol Roadmap provides a conceptual framework for the development of national policies and health systems approaches, so that potential roadblocks to cholesterol management and thus ASCVD prevention can be overcome.Methods: Through a review of published guidelines and research papers since 2017, and consultation with a committee composed of experts in clinical management of dyslipidaemias and health systems research in low-and-middle income countries (LMICs), this Roadmap identifies (1) key principles to effective ASCVD prevention (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMICs; and (4) potential strategies for overcoming these.Results: Reducing the future burden of ASCVD will require diverse approaches throughout the life-course. These include: a greater focus on primordial prevention; availability of affordable cholesterol testing; availability of universal cholesterol screening for inherited dyslipidaemias; risk stratification moving beyond 10-year risk to look at lifetime risk with adequate risk estimators; wider availability of affordable cholesterol-lowering therapies which should include statins as essential medications globally; use of adequate doses of potent statin regimens; and combination therapies with ezetimibe or other therapies in order to attain and maintain robust reductions in LDL-C in those at highest risk. Continuing efforts are needed on health literacy for both the public and healthcare providers, utilising multi-disciplinary teams in healthcare and applications that quantify both ASCVD risk and benefits of treatment as well as increased adherence to therapies.Conclusions: The adverse effects of LDL-cholesterol and apo B containing lipoprotein exposure are cumulative and result in ASCVD. These are preventable by implementation of different strategies, aimed at efficiently tackling atherosclerosis at different stages throughout the human life-course. Preventive strategies should therefore be updated to implement health policy, lifestyle changes and when needed pharmacotherapies earlier with investment in, and a shift in focus towards, early preventive strategies that preserve cardiovascular health rather than treat the consequences of ASCVD.
- Published
- 2022