The AHA Guidelines and Scientific Statements Handbook

Chapter 10 Cholesterol Management in the Context of Risk Factor Profi le

European guidelines for lipid
management

Recently a Joint Task Force of the European Society
of Cardiology and other societies on cardiovascular
disease prevention in clinical practice (constituted
by representatives of nine societies and by invited
experts) issued European guidelines of cardiovascu-
lar disease prevention recommendations for clinical
practice [18]. Included in these guidelines were rec-
ommendations for lipid management. As can be
seen in Table 10.9, these recommendations are
similar to those of the United States outlined in this
chapter. One signifi cant difference however is in the
procedure for risk assessment. Risk assessment is

Table 10.9 Management of total CVD risk-LIPIDS: European Cardiovascular Guidelines

High risk conditions: Established CVD; type 2 diabetes; type 1 diabetes with microalbuminuria; markedly raised cholesterol levels

• Dietary and exercise advice together with attention to all risk factors comes fi rst


• Aim to reduce total cholesterol to <4.5 mmol/L (~175 mg/dL) or <4 mmol/L (~155 mg/dL) if feasible, and LDL-cholesterol to <2.5 mmol/L
  (~100 mg/dL) or <2 mmol/L (~8 mg/dL) if feasible


• This may well require statin treatment in many. Some recommend statin for all CVD and most diabetic patients regardless of baseline
  levels.

SCORE risk >5%

• Lifestyle advice for 3 months, then reassess SCORE risk and fasting lipids


• If SCORE risk remains ≥5%, treat the patient according to recommendations for High Risk Conditions


• If SCORE risk is <5% and total cholesterol is below 5 mmol/L or LDL-cholesterol is <3 mmol/L, treat the patient as if baseline SCORE risk
  were <5% (see below)

SCORE risk <5%

• Lifestyle advice to reduce total cholesterol <5 mmol/L (<190 mg/dL) and LDL-cholesterol <3 mmol/L (115 mg/dL). Regular follow-up

HDL cholesterol and triglycerides

• Treatment goals are not defi ned for HDL cholesterol and triglycerides, but HDL cholesterol <1.0 mmol/L (40 mg/dL) for men and
  <1.2 mmol/L (45 mg/dL) for women and fasting triglycerides of >1.7 mmol/L (150 mg/dL) are markers for increased cardiovascular risk

done by the so-called SCORE risk chart. This chart

emphasized the multifactorial nature of CVD, and

it estimates risk for all CVD and not just CHD. It

attempts to provide a common language of risk for

clinicians. The details of the SCORE risk chart are

beyond the scope of the current chapter but are

clearly outlined in the primary document [18].

References available online at http://www.Wiley.com/go/

AHAGuidelineHandbook.

During the production of this book this relevant

AHA statement and guideline was published:

Population-Based Prevention of Obesity, http://

circ.ahajournals.org/cgi/content/full/118/4/428.