Diagnostic criteria for screening dyslipidemia and lipid management targets from the point of preventive medicine

Abstract

 Japan Atherosclerosis Society (JAS) published the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2012. Since then, these guidelines have been used as a clinical standard for prevention of atherosclerotic cardiovascular diseases in Japan. JAS guidelines were based upon the data of NIPPON DATA80 to evaluate the 10-year probability (absolute risk) of coronary artery disease death. However, in the April of 2014, the Japan Society of Ningen Dock announced at a press conference a “reference range” based upon the 95% distribution of clinical and laboratory examination data of so-called supernormal healthy subjects without any prospective data for predicting the development of coronary artery disease. This announcement resulted in a nation-wide confusion among health care providers in terms of the management and treatment of a variety of life-style related diseases. This “reference range” cannot be used for the diagnosis of diseases, estimation of future development of atherosclerotic cardiovascular diseases, and establishment of treatment targets. In contrast, the criteria for the diagnosis and treatment of dyslipidemia in the JAS guidelines are based upon the future risk estimation and prompt us to initiate life-style modification as well as diet, exercise and drug therapies. Thus, clinical judgment values as used in a variety of clinical guidelines are very important and should be used as the only standard in the clinical settings.