The evolution of European guidelines: Changing the management of cholesterol levels

• Published in: Atherosclerosis Vol. 185; no. 1; pp. 12 - 20
• Main Authors: Erhardt, Leif R., Gotto, A.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ireland Ltd 01-03-2006; Elsevier
• Subjects: Anticholesteremic Agents - therapeutic use; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiac and Cardiovascular Systems; Cardiology. Vascular system; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Cholesterol - blood; Clinical Medicine; Coronary heart disease; Europe; factors; Guidelines; Heart; Humans; Hypercholesterolemia - blood; Hypercholesterolemia - complications; Hypercholesterolemia - drug therapy; Hyperlipidemia; International Cooperation; Kardiologi; Klinisk medicin; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Miscellaneous; Practice Guidelines as Topic; Public health. Hygiene; Public health. Hygiene-occupational medicine; risk; Risk Factors; Statins; Treatment Outcome; Europe; Cardiovascular diseases; Hyperlipidemia; Statins; Risk factors; Guidelines; Lipids; Cardiovascular disease; Osteoarticular system; Vascular disease; Atherosclerosis; Evolution; Hyperlipemia; Dyslipemia; Human; Estimation; Metabolic diseases; Statin derivative; Joint; Cholesterol; Recommendation; Stress; Clinical management; Treatment; Risk factor; Society; Antilipemic agent
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2005.10.001

Cardiovascular disease (CVD) is the leading cause of death in Europe and the US. This paper reviews the evolution of the Joint European Societies’ guidelines with respect to their lipid recommendations. We stress the importance of lowering lipid levels to, or below, the currently recommended goals and argue that patients’ global risk for CVD, rather than baseline lipid levels, should direct the intensity of lipid-lowering treatment. However, the emphasis on near-term (i.e., in the next 10 years) global risk estimation may under-emphasize the importance of considering lifetime cardiovascular risk in treatment decisions. Although various guidelines’ thresholds for treatment initiation and recommended goals differ, they are similar in the theme of treating global risk. Most clinical trials have not identified a threshold of cholesterol level beyond which lowering cholesterol levels no longer provides cardiovascular benefit. An urgent call for action is needed to improve goal attainment in patients with or at risk for CVD. Improving access to risk-reducing treatments should be a priority.