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European Heart Journal Advance Access published online on June 21, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi373
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received October 13, 2004
Revised April 18, 2005
Accepted May 19, 2005

Review

Lipids and CVD management: towards a global consensus

Christie Ballantyne 1, Bruce Arroll 2, and James Shepherd 3*

1 Arteriosclerosis and Lipoprotein Section, Baylor College of Medicine, Houston, TX, USA
2 Department of General Practice and Primary Care, University of Auckland, Auckland, New Zealand
3 Department of Pathological Biochemistry, Royal Infirmary, Glasgow G4 0SF, Scotland, UK

* To whom correspondence should be addressed.
James Shepherd, E-mail: jshepherd{at}gri-biochem.org.uk


  Abstract

Cardiovascular disease (CVD) is currently the leading cause of morbidity and mortality worldwide and its incidence is likely to increase. Multiple risk factors contribute to CVD. Elevated LDL-cholesterol (LDL-C) and triglyceride levels, low HDL-cholesterol levels, hypertension, type 2 diabetes, and smoking are key modifiable risk factors. Such risk factors are present in 80-90% of coronary heart disease (CHD) patients. For many factors, modification can significantly reduce CVD incidence. For example, statin-induced LDL-C reductions reduce cardiovascular events by 24-37% and smoking cessation reduces CHD mortality by 36%. The need to identify and treat these risk factors has led many national and local groups to develop clinical practice guidelines for management of CVD. Although the aim of such guidelines is to provide practitioners with a framework to identify, prioritize, and manage patients, the plethora of guidelines can cause confusion. In addition, research indicates that guidelines are not being optimally implemented. This review considers these practical issues, highlights the common goals shared by many guidelines, and focuses on how these can be best achieved. It also highlights areas where the guidelines differ and discusses points to consider when selecting the most appropriate recommendation.

Keywords: Guidelines; Cardiovascular disease; Cholesterol; Statin.
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