What should not be done and why - cardiovascular prevention in the light of the latest recommendations
Abstract
Last guidelines for the management of dyslipidaemia show us a new concept of rationalization of the diagnostic process, treatment and follow-up of our patients. In the new guidelines there is much more discussion about what should not be done and why.
They mention a lot of particular steps which we should avoid, because they bring no benefit in the light of the latest studies. Let's go through the whole process chronologically.
According to the new guidelines we should not use the SCORE system for stratification of cardiovascular risk in patients younger than 40 years of age, in those with diabetes, chronic kidney disease or familial hypercholesterolemia. As for dyslipidaemia treatment, statins are still the drug of choice, also in the case of mixed dyslipidemia.
Fenofibrate can be added to a statin when triglyceride levels exceed 2.3 mmol/L in high-risk patients. There are several groups of patients in whom statin therapy should be avoided, e. g. patients with heart failure without other indications, patients with aortic stenosis with coronary artery disease, autoimmune diseases, dialysis-dependent CKD without other cardiovascular disease.
Treatment should be adequately monitored, over-monitoring and treatment interruptions should be avoided. Treatment goals continue to be the same - primary goal is LDL cholesterol, secondary goal non-HDL cholesterol - but not HDL cholesterol.