Closing the gap between guidelines and clinical practice for managing dyslipidemia: where are we now?

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Sohum Sheth, Maciej Banach, Peter P Toth
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引用次数: 0

Abstract

Introduction: Despite decades of research clearly illustrating the direct link between low-density lipoprotein cholesterol (LDL-C) and atherosclerotic cardiovascular disease (ASCVD) risk, LDL-C goal attainment rates are remarkably low in both the primary and secondary prevention settings.

Areas covered: Herein we detail: (1) the low rates of LDL-C goal attainment; (2) despite guidelines clearly outlining indications of use, there is suboptimal initiation, intensification, and persistence of lipid lowering therapy, especially combination therapy; (3) key clinician-related factors contributing to this gap include inconsistent risk assessments, clinical inertia, and barriers to health access; (4) LDL-C reduction is associated with reductions in risk for cardiovascular events. Increasing LDL-C goal attainment rates should be a high public health priority.

Expert opinion: There is an urgent need to rethink dyslipidemia management. Opportunities exist to overcome LDL-C goal attainment barriers, which necessitates a concerted effort from patients, clinicians, health systems, payors, pharmaceutical companies, and public health advocates. LDL-C measurement should be a performance metric for health systems. In addition, upfront use of combination therapy and polypill formulations should be encouraged. Engaging pharmacists to support drug therapy and adherence is crucial. Leveraging telehealth and electronic medical record (EMR) functionalities can enhance these efforts and ensure more effective implementation.

缩小血脂异常管理指南与临床实践之间的差距:我们现在在哪里?
导言:尽管数十年的研究清楚地表明了低密度脂蛋白胆固醇(LDL-C)与动脉粥样硬化性心血管疾病(ASCVD)风险之间的直接联系,但无论是在一级预防还是二级预防中,LDL-C 的达标率都非常低。在此,我们将详细介绍:(1)低密度脂蛋白胆固醇(LDL-C)目标实现率低;(2)尽管指南明确列出了使用指征,但降脂治疗的启动、强化和持续性均不理想,尤其是联合治疗;(3)造成这一差距的关键临床因素包括风险评估不一致、临床惰性和医疗途径障碍;(4)降低 LDL-C 与降低心血管事件风险相关。提高低密度脂蛋白胆固醇的达标率应成为公共卫生的重中之重:专家观点迫切需要重新思考血脂异常的管理问题。克服低密度脂蛋白胆固醇达标障碍的机会是存在的,这需要患者、临床医生、医疗系统、付款人、制药公司和公共卫生倡导者共同努力。低密度脂蛋白胆固醇的测量应成为医疗系统的绩效指标。此外,应鼓励前期使用联合疗法和多丸制剂。让药剂师参与支持药物治疗和坚持用药至关重要。利用远程医疗和电子病历 (EMR) 功能可以加强这些工作,并确保更有效的实施。
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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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