Comparison and interpretation of "Guidelines for the diagnosis and treatment of dyslipidemia at the basic level (2019)" and " the ESC/EAC dyslipidemia management guidelines（2019）"
- Dyslipidemia has become a worldwide problem. Cardiovascular diseases caused by dyslipidemia have a higher mortality rate than diabetes and smoking. In China, adult dyslipidemia has accounted for 40.40% of the total population, reaching 480 million people, and it has increased year by year. According to the "Guidelines for the Prevention and Treatment of Chinese Adult Dyslipidemia (2016 Revision)", China’s cardiovascular system will be between 2010 and 2030 The number of illnesses increased by approximately 9.2 million.
In 2019, China issued the "Guidelines for the Diagnosis and Treatment of Dyslipidemia (2019)" (hereinafter referred to as "China Guide"), and Europe also released the "2019 Guideline for ESC/EAC Blood Lipid Management" (hereinafter referred to as "ESC Guide"). Compare the diagnosis and treatment of dyslipidemia between China and Europe from risk assessment, monitoring indicators, treatment methods, and lipid-lowering goals. - Basic indicatorsFirst of all, the basic concept is popularized. Blood lipids are the general name of cholesterol (cholesterol), triglyceride (TG) and lipids (phospholipids, glycolipids, sterols, steroids) in serum. The blood lipids closely related to clinics are mainly cholesterol and TG. Blood lipids are insoluble in water and must be combined with a special protein, apolipoprotein (Apo) to form lipoprotein (Lp).
Among the four clinically tested blood lipids, it refers to the blood:
1) Triglyceride (TG), reference value 0.56-1.70 mmol/L;
2) Total cholesterol (TC), which is the cholesterol contained in all lipoproteins mentioned above, the reference value is 2.84-5.20 mmol/L;
3) Low-density lipoprotein cholesterol (LDL-C), 70% of cholesterol in plasma is within LDL. In simple hypercholesterolemia, the increase in plasma cholesterol concentration is related to the level of LDL-C in plasma Consistent, the reference value is 2.10-3.10 mmol/L;
4) High-density lipoprotein cholesterol (HDL-C), the reference value is 1.00-1.55 mmol/L, and the new guideline recommends greater than 0.95 mmol/L. - Risk assessmentBoth the China Guide and the ESC Guide recommend risk assessments for healthy people and patients, based on age, blood pressure, gender, smoking status and other risk indicators, and then assess the occurrence of atherosclerotic cardiovascular disease within 10 years ( The risk of atherosclerotic cardiovascular disease (ASCVD) defines the population as low-risk, medium-risk, and high-risk. Different groups of people implement different preventive measures.
The China Guide recommends life interventions for low- and middle-risk groups. The "ESC Guide" recommends drug treatment to middle-risk groups while recommending life intervention, with statins as the first choice. - Monitoring indicatorsThe "China Guide" recommends routine monitoring of blood lipids. According to hospital conditions, apolipoprotein B (Apo B) and lipoprotein (a) [Lp(a)] can be monitored.
"ESC Guide" recommends the use of Apo B instead of LDL-C testing.
Both guidelines recommend non-high-density lipoprotein cholesterol (non-HDL-C, which refers to the total cholesterol in lipoproteins other than HDL, which can be calculated) as an important reference indicator. - TreatmentThe two guidelines have basically the same opinion on the use of drugs, and some details are different. Both recommend statins as the first choice for the prevention and treatment of such diseases. If the cholesterol level does not reach the standard, it can be used in combination with other lipid-lowering drugs (such as ezetimibe) to obtain a safe and effective lipid-lowering effect For patients with normal LDL-C and high TG, when serum TG ≥ 1.7 mmol/L, first apply non-pharmacological interventions, including therapeutic diet, weight loss, alcohol consumption, and strong alcohol withdrawal.
If the TG level is only moderately and moderately elevated (2.3-5.6 mmol/L), in order to prevent and control the risk of ASCVD, although the main goal is to reduce LDL-C levels, it should also be emphasized that non-HDL-C needs to achieve the basic target value . After treatment with statins, if non-HDL-C still cannot reach the target value, fibrate and high-purity fish oil preparations can be added on the basis of statins.
For patients with severe hypertriglyceridemia, ie fasting TG ≥ 5.7 mmol/L, first consider the use of drugs that primarily reduce TG and VLDL-C (eg, fibrates, high-purity fish oil preparations, or niacin).
For those with HDL-C <1.0 mmol/L, advocate diet control and lifestyle improvement, there is no sufficient evidence of drug intervention. - Lipid-lowering targetPrecautionary suggestions given in the "China Guide":
1. For those who are at high risk of ASCVD for 10 years, primary prevention is recommended. It is recommended that LDL-C levels be reduced to below 2.6 mmol/L, and non-HDL-C levels should be reduced to below 3.4 mmol/L;
2. For people with a very high risk of ASCVD 10 years of disease, secondary prevention is recommended. It is recommended that LDL-C levels be reduced to below 1.8 mmol/L and non-HDL-C levels to below 2.6 mmol/L.
The "ESC Lipid Guide" gives more stringent control indicators. For the first time, it is emphasized that the lower the LDL-C, the better, and there is no lower limit:
1. For extremely high-risk patients, it is recommended that the LDL-C level be reduced by ≥50% from the baseline and the LDL-C level be reduced to less than 1.4 mmol/L;
2. For high-risk patients, it is recommended that the LDL-C level be lower than baseline by ≥50%, and the LDL-C level be reduced to less than 1.8 mmol/L;
3. For patients with ASCVD who have received the maximum tolerated dose of statin therapy, if a vascular event occurs again within 2 years, LDL-C can be reduced to less than 1.0 mmol/L. - ConclusionIn general, there is no major conflict between the management of dyslipidemia in China and Europe. The overall goal is still to reduce LDL-C and encourage patients to eat and exercise reasonably. The medical interventions for patients with intermediate and high-risk conditions are also generally consistent.