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New Canadian Cholesterol-Lowering Guidelines Target Immediate-Risk Group: Presented at CCC

EDMONTON, Alberta -- October 27, 2009 -- New Canadian guidelines for the diagnosis and treatment of dyslipidaemia have redefined low density lipoprotein (LDL) targets and expanded the population that should be considered for the lowest levels, according to the authors who presented and explained the new recommendations during the 2009 Canadian Cardiovascular Congress (CCC). The new guidelines, issued by the Canadian Cardiovascular Society (CCS), were published in the Canadian Journal of Cardiology and posted on the CCS website just prior to the annual meeting

"With regard to primary prevention, the guidelines are focused on the intermediate-risk group," according to Jacques Genest, MD, Director, Division of Cardiology, McGill University, Montreal, Quebec, Canada. Chair of the committee that updated the guidelines, Dr. Genest reported that the decision to include at least some intermediate-risk patients for the same aggressive lipid lowering as recommended previously for high-risk individuals is new. The change is based on recent studies which have indicated that intermediate-risk patients also can achieve important benefits at these lipid levels.

There was one modification for high-risk patients: In addition to the previous LDL goal of <2 mmol/L, the new guidelines recommend a 50% reduction in LDL from baseline. For some patients, this means bringing LDL substantially below the previous target. For example, in a patient who was not previously a candidate for aggressive therapy but has a thrombotic event at an LDL level of 3.0 mmol/L, the new guidelines suggest a target of 1.5 mmol/L.

For assessing risk, the guidelines recommend either the Framingham Risk Score or the Reynolds Risk Score. Intermediate risk is defined as 10% to 19% estimated likelihood of a thrombotic event over the next years. The LDL goal of <2 mmol/L or 50% reduction from baseline is not recommended for all intermediate-risk patients, but it is if intermediate-risk patients have an LDL of >3.5 mmol/L, if they have a total cholesterol: high density lipoprotein (HDL) ratio of >5.0, or if they are men older than 50 years or women older than 60 years with a high-sensitivity C-reactive protein (hs-CRP) level >2.0 mg/L.

Although measuring hs-CRP was identified as a useful marker of risk in the previous Canadian guidelines, the new guidelines give this marker more prominence based on results of the JUPITER trial. In JUPITER, aggressive lipid lowering was associated with benefit in patients with relatively low LDL levels but elevated hs-CRP. This study is cited in the guidelines as an important influence on the decision to expand aggressive lipid control.

CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.

[Presentation title: 2009 CCS Canadian Cholesterol Guidelines. Workshop, Sunday, October 25, 2009]

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