Cholesterol-lowering therapy: Old evidence, new guidelines--Which one to follow? A critical appraisal.
Current guidelines of the European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS), of the American College of Cardiology and the American Heart Association (ACC/AHA), and of the International Atherosclerosis Society (IAS) are all based on the same body of evidence, but come to strikingly different conclusions with regard to lipid lowering therapy. While the ESC/EAS guidelines assign appropriate treatments to distinct lipid disorders, the ACC/AHA guidelines focus exclusively on evidence from randomized controlled trials for statins, but lack advice for those lipid disorders without evidence from randomized trials. Thus, evidence based medicine in its strict sense may leave a clinically significant gap. In striking contrast, the position paper of the IAS suggests the most advanced evidence-based innovative concept of a goal of one and the same healthy cholesterol level for anyone.
Preventive Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52 - Bldg. N36, D-20246 Hamburg, Germany. Electronic address: windler@uke.uni-hamburg.de.
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Preventive Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52 - Bldg. N36, D-20246 Hamburg, Germany. Electronic address: bzyriax@uke.uni-hamburg.de.
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D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D015536:Down-Regulation; D019317:Evidence-Based Medicine / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D015415:Biomarkers; D008078:Cholesterol, LDL
Cardiovascular disease; Cholesterol lowering; Guidelines; Lipid disorders