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[PDF] 2019 ESC/EAS Guidelines for the management of dyslipidaemias

31 août 2019 · Nor do the ESC/EAS Guidelines exempt health professionals from taking into full and careful consideration the 9 Management of dyslipidaemias in different clinical settings dyslipidemias through lifestyle modifications?

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31 août 2019 · 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk☆ Authors/Task Force 

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ESC/EAS GUIDELINES

ESC/EAS Guidelines for the management

of dyslipidaemias: Addenda The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European

Atherosclerosis Society (EAS).

Developed with the special contribution of: European Association for Cardiovascular

Prevention & Rehabilitation

Authors/Task Force Members: Zeljko Reiner

(ESC Chairperson) (Croatia),

Alberico L. Catapano

*(EAS Chairperson) (Italy), Guy De Backer (Belgium), Ian Graham (Ireland), Marja-Riitta Taskinen (Finland), Olov Wiklund (Sweden), Stefan Agewall (Norway), Eduardo Alegria (Spain), M. John Chapman (France), Paul Durrington (UK), Serap Erdine (Turkey), Julian Halcox (UK), Richard Hobbs (UK), John Kjekshus (Norway), Pasquale Perrone Filardi (Italy), Gabriele Riccardi (Italy), Robert F. Storey (UK), David Wood (UK).

ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees: Jeroen Bax (CPG Chairperson

2010-2012), (The Netherlands), AlecVahanian (CPG Chairperson 2008-2010) (France), AngeloAuricchio (Switzerland),

Helmut Baumgartner (Germany), Claudio Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard

(Belgium), GerasimosFilippatos (Greece), ChristianFunck-Brentano (France), DavidHasdai (Israel), RichardHobbs (UK),

Arno Hoes (The Netherlands), Peter Kearney (Ireland), Juhani Knuuti (Finland), Philippe Kolh (Belgium),

Theresa McDonagh (UK), Cyril Moulin (France), Don Poldermans (The Netherlands), Bogdan A. Popescu (Romania),

Z

eljkoReiner (Croatia), UdoSechtem (Germany), Per AntonSirnes (Norway), MichalTendera (Poland), AdamTorbicki

(Poland), Panos Vardas (Greece), Petr Widimsky (Czech Republic), Stephan Windecker (Switzerland)

Document Reviewers: Christian Funck-Brentano (CPG Review Coordinator) (France), Don Poldermans (Co-Review

Coordinator) (The Netherlands), GuyBerkenboom (Belgium), JacquelineDe Graaf (The Netherlands), OlivierDescamps

(Belgium), Nina Gotcheva (Bulgaria), Kathryn Griffith (UK), Guido Francesco Guida (Italy), Sadi Gulec (Turkey),

YaakovHenkin (Israel), KurtHuber (Austria), Y.Antero Kesaniemi (Finland), JohnLekakis (Greece), Athanasios J.Manolis

(Greece), Pedro Marques-Vidal (Switzerland), Luis Masana (Spain), John McMurray (UK), Miguel Mendes (Portugal),

Zurab Pagava (Georgia), Terje Pedersen (Norway), Eva Prescott (Denmark), Quite´ ria Rato (Portugal), Giuseppe Rosano

(Italy), Susana Sans (Spain), Anton Stalenhoef (The Netherlands), Lale Tokgozoglu (Turkey), Margus Viigimaa (Estonia),

M. E. Wittekoek (The Netherlands), Jose Luis Zamorano (Spain).†

Other ESC entities having participated in the development of this document: Associations: Heart Failure Association.

Working Groups: Cardiovascular Pharmacology and Drug Therapy, Hypertension and the Heart, Thrombosis.

Councils: Cardiology Practice, Primary Cardiovascular Care, Cardiovascular Imaging.

The content of these European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Guidelines has been published for personaland educational use only.

No commercial use is authorized. No part of the ESC Guidelines may be translated or reproduced in any form without written permission from the ESC. Permission can be obtained

upon submission of a written request to Oxford University Press, the publisher of theEuropean Heart Journaland the party authorized to handle such permissions on behalf of the

ESC.*Corresponding authors: Zeljko Reiner (ESC Chairperson), University Hospital Center Zagreb, School of Medicine, University of Zagreb, Salata 2, 10 000 Zagreb, Croatia. Tel:

+385 1 492 0019, Fax:+385 1 481 8457, Email:zreiner@kbc-zagreb.hr, Alberico L. Catapano (EAS Chairperson), Department of Pharmacological Science, University of Milan,

Via Balzaretti, 9, 20133 Milano, Italy. Tel:+39 02 5031 8302, Fax:+39 02 5031 8386, Email:Alberico.Catapano@unimi.it

Disclaimer.The ESC Guidelines represent the views of the ESC and the EAS, and were arrived at after careful consideration of the available evidence at the time theywere written.

Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of

health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient"s

guardian or carer. It is also the health professional"s responsibility to verify the rules and regulations applicable to drugs and devices at the timeof prescription.&2011 The European Society of Cardiology and the European Atherosclerosis Association. All rights reserved. For permissions please email: journals.permissions@oup.com.

European Heart Journal

doi:10.1093/eurheartj/ehr169

The disclosure forms of the authors and reviewers are available on the ESC websitewww.escardio.org/guidelines

Keywordsdyslipidaemia†cholesterol†triglycerides†treatment†cardiovascular diseases†guidelines

Table of Contents

Addenda on the ESC website:

Addendum I. SCORE charts with high-density lipoprotein- cholesterol Addendum II. Practical approach to reach low-density lipoprotein-cholesterol goal Addendum III. Inhibitors and inducers of enzymatic pathways involved in statin metabolism Addendum IV. Additional references (given by sections of the

Table of contents of the Guidelines)

1. Preamble

2. Introduction

2.1 Scope of the problem

2.2 Dyslipidaemias

3. Total cardiovascular risk

3.1 Total cardiovascular risk estimation

3.2 Risk levels

4. Evaluation of laboratory lipid and apolipoprotein parameters

5. Treatment targets

6. Lifestyle modifications to improve the plasma lipid profile

6.1 The influence of lifestyle on total cholesterol and

low-density lipoprotein-cholesterol levels

6.2 The influence of lifestyle on triglyceride levels

6.3 The influence of lifestyle on high-density

lipoprotein-cholesterol levels

6.4 Dietary supplements and functional foods active on

plasma lipid values

6.5 Lifestyle recommendations

7. Drugs for treatment of hypercholesterolaemia

7.1 Statins

7.2 Bile acid sequestrants

7.3 Cholesterol absorption inhibitors

7.4 Nicotinic acid

7.5 Drug combinations

7.5.1 Statins and bile acid sequestrants

7.5.2 Statins and cholesterol absorption inhibitors

7.5.3 Other combinations

7.6 Low-density lipoprotein apheresis

7.7 Future perspectives8. Drugs for treatment of hypertriglyceridaemia

8.1 Management of hypertriglyceridaemia

8.2 Fibrates

8.3 Nicotinic acid

8.4n-3 fatty acids

8.5 Drug combinations

8.5.1 Statins and fibrates

8.5.2 Statins and nicotinic acid

8.5.3 Statins andn-3 fatty acids

9. Drugs affecting high-density lipoprotein

9.1 Statins

9.2 Fibrates

9.3 icotinic acid

9.4 Cholesterylester transfer protein inhibitors

9.5 Future perspectives

10. Management of dyslipidaemias in different clinical settings

10.1 Familial dyslipidaemias

10.1.1 Familial combined hyperlipidaemia

10.1.2 Familial hypercholesterolaemia

10.1.3 Familial dysbetalipoproteinaemia

10.1.4 Familial lipoprotein lipase deficiency

10.1.5 Other genetic disorders of lipoprotein metabolism

10.2 Children

10.3 Women

10.4 The elderly

10.5 Metabolic syndrome and diabetes

10.6 Patients with acute coronary syndrome and patients

undergoing percutaneous coronary intervention

10.7 Heart failure and valvular disease

10.8 Autoimmune diseases

10.9 Renal disease

10.10 Transplantation patients

10.11 Peripheral arterial disease

10.12 Stroke

10.13 Human immunodeficiency virus patients

11. Monitoring of lipids and enzymes in patients on lipid-lowering

drug therapy

12. How to improve adherence to lifestyle changes and

compliance with drug therapy

ESC/EAS GuidelinesPage 2 of 18

Addendum I. SCORE charts with high-density lipoprotein-cholesterol included

ESC/EAS GuidelinesPage 3 of 18

ESC/EAS GuidelinesPage 4 of 18

ESC/EAS GuidelinesPage 5 of 18

ESC/EAS GuidelinesPage 6 of 18

ESC/EAS GuidelinesPage 7 of 18

ESC/EAS GuidelinesPage 8 of 18

ESC/EAS GuidelinesPage 9 of 18

ESC/EAS GuidelinesPage 10 of 18

Addendum II. Practical approach to reach low-density lipoprotein-cholesterol goal

The proposed approach requires the estimation of the distance from the target that can easily be obtained by the use of the following table.

Once the distance from a target is determined, then by interpolation the average response to a statin can be determined and the drugs that

can help in reaching that target identified from the figure.

Intolerance to a statin, clinical conditions of the patient, and possible interactions with concomitant drugs should also be taken in account.

TablePercentage reduction of LDL-C requested to

achieve goals as a function of the starting value

STARTING LDL-C

mmol/L ~mg/dL% REDUCTION TO REACH LDL-C <1.8 mmol/L (~70 mg/dL)<2.5 mmol/ (~100 mg/dL)<3 mmol/L (~115 mg/dL) >6.2 >240 >70 >60 >55

5.2-6.2 200-240 65-70 50-60 40-55

4.4-5.2 170-200 60-65 40-50 30-45

3.9-4.4 150-170 55-60 35-40 25-30

3.4-3.9 130-150 45-55 25-35 10-25

2.9-3.4 110-130 35-45 10-25 <10

2.3-2.9 90-110 22-35 <10 -

1.8-2.3 70-90 <22

FigureA systematic review and meta-analysis on the therapeutic equivalence of statins.

ESC/EAS GuidelinesPage 11 of 18

Addendum III. Inhibitors and inducers of enzymatic pathways involved in statin metabolism

For more information, see US FDA website with information for health professionals (drugs):www.fda.gov/Drugs/ResourcesFor You/

HealthProfessionals/default.htm

CYP substrates Inhibitors Inducers

CYP3A4

Atorvastatin,

lovastatin, simvastatinKetoconazole, itraconazole, fluconazole, erythromycin, clarithromycin, tricyclic antidepressants, nefazodone, venlafaxine, fluvoxamine, fluoxetine, sertraline, cyclosporin A, tacrolimus, mibefradil, amiodarone, danazol, diltiazem, verapamil, protease inhibitors, midazolam, corticosteroids, grapefruit juice, tamoxifenPhenytoin, phenobarbital, barbiturates, rifampin, dexamethasone, cyclophosphamide, carbamazepine, omeprazole,

St John"s Wort

CYP2C9

Fluvastatin,

rosuvastatin, pitavastatinKetoconazole, fluconazole, amiodarone, sulfaphenazole, oxandrolone, dronedarone, warfarinRifampicin, phenobarbital, phenytoin

Transporter

protein substrates Inhibitors Inducers

MDR/P-gp

Atorvastatin,

lovastatin, pravastatin, simvastatin, pitavastatinRitonavir, ciclosporin, verapamil, erythromycin, ketoconazole, itraconazole, quinidine, elacridar Rifampicin,

St John"s Wort

OATP1B1

All statinsCiclosporin, rifampicin,

gemfibrozil, gemfibrozil-O-glucuronide, clarithromycin, erythromycin, roxithromycin, telithromycin, indinavir, ritonavir, saquinavir UGT substrates Inhibitors Inducers

Atorvastatin,

lovastatin, pravastatin, simvastatinGemfibrozil, ciclosporin Rifampicin

ESC/EAS GuidelinesPage 12 of 18

Addendum IV. Additional

references References in addition to those listed in the full text document of the ESC/EAS Guidelines on the management of dyslipidaemias.

These additional references are given by section.

1. Preamble

2. Introduction

No additional references

3. Total cardiovascular risk

†Ankle Brachial Index Collaboration, Fowkes FG, Murray GD, Butcher I, Heald CL, Lee RJ, Chambless LE, Folsom AR, Hirsch AT, Dramaix M, DeBacker G, Wautrecht JC, Kornitzer M, Newman AB, Cushman M, Sutton-Tyrrell K, Fowkes FG, Lee AJ, Price JF, d"Agostino RB, Murabito JM, Norman PE,

Jamrozik K, Curb JD, Masaki KH, Rodrı

´guez BL, Dekker JM, Bouter LM,

Heine RJ, Nijpels G, Stehouwer CD, Ferrucci L, McDermott MM, Stoffers HE, Hooi JD, Knottnerus JA, Ogren M, Hedblad B, Witteman JC, Breteler MM, Hunink MG, Hofman A, Criqui MH, Langer RD, Fronek A, Hiatt WR, Hamman R, Resnick HE, Guralnik J, McDermott MM. Ankle brachial index com- bined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis.JAMA2008;300:197-208. †Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, Najjar SS, Rembold CM, Post WS; American Society of Echocardiography Carotid Intima- Media Thickness Task Force. Use of carotid ultrasound to identify subclinical vas- cular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine.J Am Soc Echocardiogr

2008;21:93-111.

†Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, Paul N, Clouse ME, Shapiro EP, Hoe J, Lardo AC, Bush DE, de Roos A, Cox C, Brinker J, Lima JA. Diagnostic performance of coronary angiography by 64-row CT.N Engl J

Med2008;359:2324-2336.

†Aktas MK, Ozduran V, Pothier CE, Lang R, Lauer MS. Global risk scores and exer- cise testing for predicting all-cause mortality in a preventive medicine program.

JAMA2004;292:1462-1468.

†Catapano AL, Pedersen TR, De Backer G, Averting a pandemic health crisis in Europe by 2020: what physicians need to know regarding cholesterol manage- ment.Eur J Cardiovasc Prev Rehabil2007;14:340-345. †Vartiainen E, Jousilahti P, Alfthan G, Sundvall J, Pietinen P, Puska P. Cardiovascular risk factor changes in Finland, 1972-1997.Int J Epidemiol2000;29:49-56. †Wilson P, Pencina M, Jacques P, Selhub J, D"Agostino R, O"Donnell. C-reactive protein and reclassification of cardiovascular risk in the Framingham Heart

Study.Circ Cardiovasc Qual Outcomes2008;1:92-97.

4. Evaluation of laboratory lipid and apolipoprotein parameters

†Ridker PM, Rifai N, Cook NR, Bradwin G, Buring JE. Non-HDL cholesterol, apo- lipoproteins A-I and B100, standard lipid measures, lipid ratios, and CRP as risk factors for cardiovascular disease in women.JAMA2005;294:326-333. †Gotto AM Jr. Triglyceride as a risk factor for coronary artery disease.Am J Cardiol

1998;82:22Q-25Q.

†Ridker PM. Fasting versus nonfasting triglycerides and the prediction of cardiovas- cular risk: do we need to revisit the oral triglyceride tolerance test?Clin Chem

2008;54:11-13.

†Abdel-Maksoud MF, Hokanson JE. The complex role of triglycerides in cardiovas- cular disease.Semin Vasc Med2002;2:325-333. †Briel M, Ferreira-Gonzalez I, You JJ, Karanicolas PJ, Akl EA, Wu P, Blechacz B, Bassler D, Wei X, Sharman A, Whitt I, Alves da Silva S, Khalid Z, Nordmann AJ, Zhou Q, Walter SD, Vale N, Bhatnagar N, O"Regan C, Mills EJ, Bucher HC, Montori VM, Guyatt GH. Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mor- tality: systematic review and meta-regression analysis.BMJ2009;338:b92. †Barter PJ, Ballantyne CM, Carmena R, Castro Cabezas M, Chapman MJ, Couture P, de Graaf J, Durrington PN, Faergeman O, Frohlich J, Furberg CD, Gagne C, Haffner SM, Humphries SE, Jungner I, Krauss RM, Kwiterovich P, Marcovina S, Packard CJ, Pearson TA, Reddy KS, Rosenson R, Sarrafzadegan N, Sniderman AD, Stalenhoef AF, Stein E, Talmud PJ, Tonkin AM, Walldius G,

Williams KM. Apo B versus cholesterol in estimating cardiovascular risk and inguiding therapy: report of the thirty-person/ten-country panel.J Intern Med

2006;259:247-258.

†van der Steeg WA, Boekholdt SM, Stein EA, El-Harchaoui K, Stroes ES, Sandhu MS, Wareham NJ, Jukema JW, Luben R, Zwinderman AH, Kastelein JJ, Khaw KT. Role of the apolipoprotein B-apolipoprotein A-I ratio in cardiovascular risk assessment: a case-control analysis in EPIC-Norfolk.Ann Intern Med2007;

146:640-648.

†Langlois MR, Blaton VH. Historical milestones in measurement of HDL-cholesterol: impact on clinical and laboratory practice.Clin Chim Acta2006;369:168-178. †Nazir DJ, Roberts RS, Hill SA, McQueen MJ. Monthly intra-individual variation in lipids over a 1-year period in 22 normal subjects.Clin Biochem1999;32:381-389. †Hellerud C, Burlina A, Gabelli C, Ellis JR, Nyholm PG, Lindstedt S. Glycerol metabolism and the determination of triglycerides—clinical, biochemical and mol- ecular findings in six subjects.Clin Chem Lab Med2003;41:46-55. †Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low- density lipoprotein cholesterol in plasma, without use of the preparative ultracen-quotesdbs_dbs24.pdfusesText_30