Special Article
Canadian Cardiovascular Society position statement – Recommendations for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular diseaseDocument de principes de la Société canadienne de cardiologie : Recommandations pour diagnostiquer et traiter la dyslipidémie et prévenir la maladie cardiovasculaire

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Since the last publication of the recommendations for the management and treatment of dyslipidemia, new clinical trial data have emerged that support a more vigorous approach to lipid lowering in specific patient groups. The decision was made to update the lipid guidelines in collaboration with the Canadian Cardiovascular Society. A systematic electronic search of medical literature for original research consisting of blinded, randomized controlled trials was performed. Meta-analyses of studies of the efficacy and safety of lipid-lowering therapies, and of the predictive value of established and emerging risk factors were also reviewed. All recommendations are evidence-based, and have been reviewed in detail by primary and secondary review panels. Major changes include a lower low-density lipoprotein cholesterol (LDL-C) treatment target (lower than 2.0 mmol/L) for high-risk patients, a slightly higher intervention point for the initiation of drug therapy in most low-risk individuals (LDL-C of 5.0 mmol/L or a total cholesterol to high-density lipoprotein cholesterol ratio of 6.0) and recommendations regarding additional investigations of potential use in the further evaluation of coronary artery disease risk in subjects in the moderate-risk category.

Depuis la dernière publication des recommandations pour prendre en charge et traiter la dyslipidémie, de nouvelles données d’essai clinique ont été colligées qui soutiennent une démarche hypolipidémiante plus vigoureuse dans des groupes de patients précis. Il a été décidé de mettre à jour les lignes directrices au sujet des lipides en collaboration avec la Société canadienne de cardiologie. On a effectué une recherche électronique systématique des publications médicales afin de trouver des recherches originales sous forme d’essais aléatoires et contrôlés en aveugle. Des méta-analyses d’études sur l’efficacité et l’innocuité des traitements hypolipidémiants et sur la valeur prédictive de facteurs de risque établis et émergents ont également été examinées. Les principaux changements incluent un traitement ciblé pour baisser davantage le cholestérol à lipoprotéines de basse densité (C-LDL) (à moins de 2,0 mmol/L) pour les patients très vulnérables, un point d’intervention légèrement plus élevé pour entreprendre la pharmacothérapie de la plupart des individus à faible risque (C-LDL de 5,0 mmol/L ou un ratio de 6.0 entre le cholestérol total et le cholestérol à lipoprotéines de haute densité) et la recommandation de mener des recherches supplémentaires sur l’utilité potentielle de mieux évaluer le risque de maladie coronarienne chez des sujets dans la catégorie de risque modéré.

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