Lipid Management for Prevention of Atherosclerotic Cardiovascular Diseases

Abstract

 In the Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases published by the Japan Atherosclerosis Society, the risks were evaluated based upon the 10-year prevalence of coronary artery disease (CAD) by the Suita Score which determined both LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) levels. Hyperuricemia and sleep apnea syndrome were included as a high-risk state. Abdominal aortic aneurysm and renal artery stenosis were designated as a high-risk state. For the diagnosis of dyslipidemia, hyper-non-HDL-cholesterolemia and borderline hyper-non-HDL-cholesterolemia have been added to the previous classification, including hyper-LDL-cholesterolemia, borderline hyper-LDL-cholesterolemia, hypo-HDL-cholesterolemia, and hypertriglyceridemia. For estimation of LDL-C, direct LDL-C methods can be used as well as Friedewald's equation. In cases with TG≥400 mg/dL or in a nonfasting condition, direct LDL-C methods or non-HDL-C should be used. For primary prevention, patients with diabetes, chronic kidney disease (CKD), noncardiogenic cerebral infarction or peripheral artery disease (PAD) are classified as high-risk group. Patients without any of these diseases, 10-year prevalence of coronary artery disease is calculated using Suita score and patients are classified into low-risk, medium-risk or high-risk group. Thus, the target lipid levels are determined. For secondary prevention, LDL-C should be less than 100 mg/dL, however in cases of familial hypercholesterolemia (FH), acute coronary syndrome (ACS) or diabetes with a high-risk state, LDL-C less than 70 mg/dL should be considered. The diagnosis and treatment of patients with FH have been described in detail because new drugs such as PCSK9 inhibitors (evolocumab and alirocumab) and an MTP inhibitor (lomitapide) have been launched. For pediatric FH patients, statins are now the first line drug. Patients with FH should be diagnosed and treated as early as possible, thus annual health check is very important. A selective PPARα modulator (pemafibrate) has been on market for the treatment of hypertriglyceridemia. In the current review, the guidelines for prevention of atherosclerotic cardiovascular diseases with special focus on treatment of dyslipidemia are described.