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Comment to the position paper on global recommendations for the management of dyslipidemia developed by the International Atherosclerosis Society (IAS)

In a previous issue of Atherosclerosis a summary of the position paper on Global Recommendations for the Management of Dyslipidemia, developed by the International Atherosclerosis Society (IAS) was published. The European perspective on the treatment of dyslipidaemia was recently published in the guidelines on dyslipidaemia developed by EAS and ESC (EAS/ESC Guidelines for the Treatment of Dyslipidaemia) [1], followed by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice [2]. The EAS/ESC guidelines on dyslipidaemia were developed for Europe but the guidelines have been adopted by several countries outside Europe. The current position paper from IAS emphasizes the global perspective of atherosclerosis, the associated clinical manifestations and their prevention. Dyslipidaemia is put into focus as a major target in prevention. In most countries of Europe cardiovascular mortality and morbidity have been reduced since the seventies ; however it still is a major cause of death and disability, and the reduction is levelling off and in some countries a backlash is seen. In developing countries, in Asia and in Africa atherosclerosis related diseases are expected to become the main cause of death within coming decades. A major cause of this is the “westernisation” of lifestyle with changing dietary habits and a more sedentary life. A consequence is an increased frequency of dyslipidaemia and of type 2 diabetes, two major risk factors for ischaemic vascular disease. To address this development all efforts have to be combined and the initiative of IAS is an additional contribution in these efforts. Taking a global perspective the immense variation in local circumstances regarding economical possibilities, traditional lifestyles, nutritional habits and socioeconomic circumstances has to be taken into account. Thus a position paper with global ambitions has to be more general than what can be written in local guidelines and this is reflected by the tone of the IAS statement. The goals outlined in the position paper are well in line with the guidelines developed in Europe: the focus on atherogenic lipoproteins, the focus on lifestyle changes in primary prevention and statin treatment in high risk subjects in primary and in secondary prevention is also shared. The position paper also emphasizes the importance of total cardiovascular risk estimation when approaching the individual person ; whether the use of the Framingham equation is appropriate in all populations of the world remains to be addressed. The optimal levels of atherogenic lipoproteins are adapted to the individual total cardiovascular risk in order to give priority to treatment of the patients most in need, as well as to optimize the cost benefit of treatment. As discussed in more detail in the EAS/ESC guidelines, also the familial dyslipidaemias, e.g. familial hypercholesterolaemia, should be a prioritized group for treatment and this has been further emphasized in recent consensus papers from EAS [3] and [4]. Minor discrepancies between documents in numbers should not obscure the fact that the strategies for cardiovascular prevention and treatment of dyslipidaemia are similar in available guidelines and position papers. Prevention should be put into a global perspective. However the strategies have to be locally adopted according to local circumstances and we have to accept that global guidelines cannot and should not be developed on a practical clinical level, rather should we accept a common ground for the strategies which should be modified according to local circumstances.

position paper; dyslipidemia; International Atherosclerosis Society

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