Expert opinion on the applicability of dyslipidemia guidelines in Asia and the Middle East

Abstract

Mostafa Alshamiri,1 Mahmood Mohammed Ali Ghanaim,2 Philip Barter,3 Kuan-Cheng Chang,4 Jian-Jun Li,5 Bien J Matawaran,6 Anwar Santoso,7 Sameh Shaheen,8 Ketut Suastika,9 Nuntakorn Thongtang,10 Ahmad KM Yusof11 1Cardiac Science Department, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Emergency Department, Dubai Hospital, Dubai, United Arab Emirates; 3School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia; 4Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; 5Center for Dyslipidemia and Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Science and Peking Union Medical School, Beijing, People’s Republic of China; 6Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Santo Tomas, Manila, Philippines; 7Department of Cardiology – Vascular Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Depok, Indonesia; 8Department of Cardiology, Ain Shams University School of Medicine, Cairo, Egypt; 9Division of Endocrinology and Metabolism, Faculty of Medicine, Udayana University, Denpasar, Indonesia; 10Division of Endocrinology and Metabolism, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 11Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia Abstract: Cardiovascular disease (CVD) is a growing burden across the world. In Asia and the Middle East, in particular, CVD is among the most prevalent and debilitating diseases. Dyslipidemia is an important factor in the development of atherosclerosis and associated cardiovascular events, and so effective management strategies are critical to reducing overall cardiovascular risk. Multiple dyslipidemia guidelines have been developed by international bodies such as the European Society of Cardiology/European Atherosclerosis Society and the American College of Cardiology/American Heart Association, which all have similarities in practice recommendations for the optimal management of dyslipidemia. However, they differ in certain aspects including pharmacological treatment, lifestyle modification and the target levels used for low-density lipoprotein cholesterol. The evidence behind these guidelines is generally based on data from Western populations, and their applicability to people in Asia and the Middle East is largely untested. As a result, practitioners within Asia and the Middle East continue to rely on international evidence despite population differences in lipid phenotypes and CVD risk factors. An expert panel was convened to review the international guidelines commonly used in Asia and the Middle East and determine their applicability to clinical practice in the region, with specific recommendations, or considerations, provided where current guideline recommendations differ from local practice. Herein, we describe the heterogeneous approaches and application of current guidelines used to manage dyslipidemia in Asia and the Middle East. We provide consensus management recommendations to cover different patient scenarios, including primary prevention, elderly, chronic kidney disease, type 2 diabetes, documented CVD, acute coronary syndromes and family history of ischemic heart disease. Moreover, we advocate for countries within the Asian and Middle East regions to continue to develop guidelines that are appropriate for the local population. Keywords: Asia, dyslipidemia, guidelines, Middle East, cardiovascular disease

Keywords

• Asia
• dyslipidemia
• guidelines
• Middle East
• cardiovascular disease