World Heart Federation Cholesterol Roadmap 2022. Issue 1 (14th October 2022)

• Record Type: Journal Article
• Authors: Ray, Kausik K.; Ference, Brian A.; Séverin, Tania; Blom, Dirk; Nicholls, Stephen J.; Shiba, Mariko H.; Almahmeed, Wael; Alonso, Rodrigo; Daccord, Magdalena; Ezhov, Marat; Olmo, Rosa Fernández; Jankowski, Piotr; Lanas, Fernando; Mehta, Roopa; Puri, Raman; Wong, Nathan D.; Wood, David; Zhao, Dong; Gidding, Samuel S.; Virani, Salim S.; Lloyd-Jones, Donald; Pinto, Fausto; Perel, Pablo; Santos, Raul D.
• Is Part Of: Global heart. Volume 17:Issue 1(2022)
• Publication Date: 2022-10-14
• Subjects: cholesterol -- low-density lipoprotein cholesterol prevention -- ASCVD -- lipid lowering therapy -- familial hypercholesterolaemia; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; Cardiovascular system -- Diseases -- Prevention; Cardiovascular Diseases -- prevention & control -- Periodicals; Cardiovascular Diseases -- Periodicals; Developing Countries -- Periodicals; Electronic journals; Electronic journals; Periodicals; 616.1005
• DOI: 10.5334/gh.1154
• Languages: English
• ISSNs: 2211-8160

Abstract

Background: Atherosclerotic cardiovascular diseases (ASCVD) including myocardial infarction, stroke and peripheral arterial disease continue to be major causes of premature death, disability and healthcare expenditure globally. Preventing the accumulation of cholesterol-containing atherogenic lipoproteins in the vessel wall is central to any healthcare strategy to prevent ASCVD. Advances in current concepts about reducing cumulative exposure to apolipoprotein B (apo B) cholesterol-containing lipoproteins and the emergence of novel therapies provide new opportunities to better prevent ASCVD. The present update of the World Heart Federation Cholesterol Roadmap provides a conceptual framework for the development of national policies and health systems approaches, so that potential roadblocks to cholesterol management and thus ASCVD prevention can be overcome. Methods: Through a review of published guidelines and research papers since 2017, and consultation with a committee composed of experts in clinical management of dyslipidaemias and health systems research in low-and-middle income countries (LMICs), this Roadmap identifies (1) key principles to effective ASCVD prevention (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMICs; and (4) potential strategies for overcoming these. Results: Reducing the future burden of ASCVD will require diverse approaches throughout the life-course. These include: a greater focus on primordial prevention; availability of affordable cholesterol testing; availability of universal cholesterol screening for inherited dyslipidaemias; risk stratification moving beyond 10-year risk to look at lifetime risk with adequate risk estimators; wider availability of affordable cholesterol-lowering therapies which should include statins as essential medications globally; use of adequate doses of potent statin regimens; and combination therapies with ezetimibe or other therapies in order to attain and maintain robust reductions in LDL-C in those at highest risk. Continuing efforts are needed on health literacy for both the public and healthcare providers, utilising multi-disciplinary teams in healthcare and applications that quantify both ASCVD risk and benefits of treatment as well as increased adherence to therapies. Conclusions: The adverse effects of LDL-cholesterol and apo B containing lipoprotein exposure are cumulative and result in ASCVD. These are preventable by implementation of different strategies, aimed at efficiently tackling atherosclerosis at different stages throughout the human life-course. Preventive strategies should therefore be updated to implement health policy, lifestyle changes and when needed pharmacotherapies earlier with investment in, and a shift in focus towards, early preventive strategies that preserve cardiovascular health rather than treat the consequences of ASCVD.