Primary, secondary and tertiary preventions in the kaleidoscope of newer lipid guidelines
Pécsi Tudományegyetem, Klinikai Központ, I. sz. Belgyógyászati Klinika, Endokrinológiai és Anyagcsere Tanszék, Pécs
Even at extremely low cholesterol levels cardiovascular events do not show a J curve and neither are the side effects more common. As a result of the cardiovascular risk classification, the most important question refers to lipid therapy, whether cholesterol lowering is necessary and if so, what target and starting dose should be considered. According to the Guidelines of European Atherosclerosis Society, statin is currently to be considered at 1 to 4% SCORE and from 2.6 mmol/L LDL-C that is deeply below median values, if uncontrolled by lifestyle interventions. The new American ACC/AHA cholesterol management guidelines recommend the use of thresholds for LDL-C targets in some cases again, but these have become more conservative and overcomplicated with regard for primary prevention. An LDL-C target below 1.4 mmol/L in the extreme high risk category appeared in the recommendations. Regarding usage of non-statin drugs and/or treatments of elderly, the guidelines are fairly divided, in both primary and secondary preventions. The dose or drug dependence of “statin intolerance” has not been demonstrated in randomized controlled trials. Most of the potential side effects listed in leaflets are not evidence based, while they may generate complaints by a nocebo effect.