World Heart Federation Cholesterol Roadmap 2022
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 lipopr...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Ubiquity Press
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562775/ https://www.ncbi.nlm.nih.gov/pubmed/36382159 http://dx.doi.org/10.5334/gh.1154 |
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author | 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. |
author_facet | 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. |
author_sort | Ray, Kausik K. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9562775 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Ubiquity Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-95627752022-11-14 World Heart Federation Cholesterol Roadmap 2022 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. Glob Heart Official Whf Document 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. Ubiquity Press 2022-10-14 /pmc/articles/PMC9562775/ /pubmed/36382159 http://dx.doi.org/10.5334/gh.1154 Text en Copyright: © 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Official Whf Document 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. World Heart Federation Cholesterol Roadmap 2022 |
title | World Heart Federation Cholesterol Roadmap 2022 |
title_full | World Heart Federation Cholesterol Roadmap 2022 |
title_fullStr | World Heart Federation Cholesterol Roadmap 2022 |
title_full_unstemmed | World Heart Federation Cholesterol Roadmap 2022 |
title_short | World Heart Federation Cholesterol Roadmap 2022 |
title_sort | world heart federation cholesterol roadmap 2022 |
topic | Official Whf Document |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9562775/ https://www.ncbi.nlm.nih.gov/pubmed/36382159 http://dx.doi.org/10.5334/gh.1154 |
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