title: 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult.
abstract: Since the publication of the 2012 guidelines new literature has emerged to inform decision-making. The 2016 guidelines primary panel selected a number of clinically relevant questions and has produced updated recommendations, on the basis of important new findings. In subjects with clinical atherosclerosis, abdominal aortic aneurysm, most subjects with diabetes or chronic kidney disease, and those with low-density lipoprotein cholesterol ≥ 5 mmol/L, statin therapy is recommended. For all others, there is an emphasis on risk assessment linked to lipid determination to optimize decision-making. We have recommended nonfasting lipid determination as a suitable alternative to fasting levels. Risk assessment and lipid determination should be considered in individuals older than 40 years of age or in those at increased risk regardless of age. Pharmacotherapy is generally not indicated for those at low Framingham Risk Score (FRS; <10%). A wider range of patients are now eligible for statin therapy in the FRS intermediate risk category (10%-19%) and in those with a high FRS (> 20%). Despite the controversy, we continue to advocate for low-density lipoprotein cholesterol targets for subjects who start therapy. Detailed recommendations are also presented for health behaviour modification that is indicated in all subjects. Finally, recommendation for the use of nonstatin medications is provided. Shared decision-making is vital because there are many areas in which clinical trials do not fully inform practice. The guidelines are meant to be a platform for meaningful conversation between patient and care provider so that individual decisions can be made for risk screening, assessment, and treatment.
authors.affiliation: Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: todd.anderson@ahs.ca.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Anderson
authors.affiliation: Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Grégoire
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Pearson
authors.affiliation: Chilliwack General Hospital, Chilliwack, British Columbia, Canada.
authors.forename: Arden R
authors.initials: AR
authors.lastname: Barry
authors.affiliation: Centre Hospitalier de l'Université Laval, Laval, Québec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Couture
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.affiliation: St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Francis
authors.affiliation: McGill University Health Centre, Montréal, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Genest
authors.affiliation: Montréal General Hospital and McGill University, Montréal, Québec, Canada.
authors.forename: Steven
authors.initials: S
authors.lastname: Grover
authors.affiliation: McMaster University, Hamilton, Ontario, Canada; St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Milan
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Robarts Research Institute, London, Ontario, Canada.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hegele
authors.affiliation: Julia MacFarlane Diabetes Research Centre, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: David C
authors.initials: DC
authors.lastname: Lau
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Leiter
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Ruth
authors.initials: R
authors.lastname: McPherson
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ngui
authors.affiliation: Institut Universitaire de cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
authors.affiliation: St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John L
authors.initials: JL
authors.lastname: Sievenpiper
authors.affiliation: Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: James A
authors.initials: JA
authors.lastname: Stone
authors.affiliation: McGill University Health Centre, Montréal, Québec, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Thanassoulis
authors.affiliation: Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Ward
mesh_terms: D000328:Adult; D017544:Aortic Aneurysm, Abdominal / Q000150:complications; D050197:Atherosclerosis / Q000150:complications; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D017023:Coronary Angiography; D048909:Diabetes Complications; D004032:Diet; D050171:Dyslipidemias / Q000628:therapy*; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008019:Life Style; D008055:Lipids / Q000097:blood; D008403:Mass Screening; D011322:Primary Prevention; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy; D018570:Risk Assessment; D016540:Smoking Cessation; D013315:Stress, Psychological / Q000517:prevention & control; D061205:Vascular Calcification / Q000000981:diagnostic imaging
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008055:Lipids