Use of expert consensus to improve atherogenic dyslipidemia management.
OBJECTIVE
Although atherogenic dyslipidemia is a recognized cardiovascular risk factor, it is often underassessed and thus undertreated and poorly controlled in clinical practice. The objective of this study was to reach a multidisciplinary consensus for the establishment of a set of clinical recommendations on atherogenic dyslipidemia to optimize its prevention, early detection, diagnostic evaluation, therapeutic approach, and follow-up.


METHODS
After a review of the scientific evidence, a scientific committee formulated 87 recommendations related to atherogenic dyslipidemia, which were grouped into 5 subject areas: general concepts (10 items), impact and epidemiology (4 items), cardiovascular risk (32 items), detection and diagnosis (19 items), and treatment (22 items). A 2-round modified Delphi method was conducted to compare the opinions of a panel of 65 specialists in cardiology (23%), endocrinology (24.6%), family medicine (27.7%), and internal medicine (24.6%) on these issues.


RESULTS
After the first round, the panel reached consensus on 65 of the 87 items discussed, and agreed on 76 items by the end of the second round. Insufficient consensus was reached on 3 items related to the detection and diagnosis of atherogenic dyslipidemia and 3 items related to the therapeutic goals to be achieved in these patients.


CONCLUSIONS
The external assessment conducted by experts on atherogenic dyslipidemia showed a high level of professional agreement with the proposed clinical recommendations. These recommendations represent a useful tool for improving the clinical management of patients with atherogenic dyslipidemia. A detailed analysis of the current scientific evidence is required for those statements that eluded consensus.
Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain. Electronic address: jesus.millan@salud.madrid.org.
Jesús
J
Millán Núñez-Cortés
Unidad de Lípidos, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Juan
J
Pedro-Botet
Servicio de Medicina Interna, Hospital San Pedro, Logroño, La Rioja, Spain.
Ángel
Á
Brea-Hernando
Centro de Salud de Bembibre, Bembibre, León, Spain.
Ángel
Á
Díaz-Rodríguez
Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
Pedro
P
González-Santos
Servicio de Endocrinología, Hospital Universitario Dr. Peset, Universitat de València, Valencia, Spain.
Antonio
A
Hernández-Mijares
Centro de Salud Prosperidad, Madrid, Spain.
Teresa
T
Mantilla-Morató
Servicio de Medicina Interna, Hospital de Bellvitge, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
Xavier
X
Pintó-Sala
Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
Rafael
R
Simó
D050197:Atherosclerosis / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D032921:Consensus; D003697:Delphi Technique; D050171:Dyslipidemias / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods*; D017408:Guidelines as Topic; D006801:Humans; D012307:Risk Factors
Atherogenic dyslipidemia; Cardiovascular risk; Consenso; Consensus; Delphi; Dislipemia aterogénica; HDL-C; LDL-C; Riesgo cardiovascular; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol