ESC Congress 2016 - 7

Your FREE access to ESC Congress content all year long www.escardio.org/365 ESC CONGRESS 2016 IN REVIEW GUIDELInES FOR THE MAnAGEMEnT OF DySLIPIDEMIAS Task force chairs Ian Graham, MD, Hermitage Medical Clinic, Dublin, Ireland, and Alberico L. Catapano, MD, University of Milan, Milan, Italy, summarized the key recommendations of the 2016 ESC/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias [Catapano AL et al. Eur Heart J. 2016]. CVD risk is usually the result of multiple, interacting risk factors. The dyslipidemia recommendations for risk estimation are shown in Table 5. The guidelines state that low-density lipoprotein cholesterol (LDL-C) must be used as the primary lipid analysis. High-density lipoprotein cholesterol (HDL-C) should be analyzed before starting treatment. Triglyceride levels are recommended for diagnosis and choice of treatment. Lipoprotein(a) screening should be considered for individuals with premature CVD, familial hypercholesterolemia, a family history of premature CVD or elevated lipoprotein(a), recurrent CVD despite optimal lipid-lowering treatment, or ≥ 5% 10-year risk of fatal CVD according to SCORE. Treatment targets for managing dyslipidemia (Table 4) are needed to monitor results of treatment and adjust therapy when needed. Recommended LDL-C interventions based on total CV risk are shown in Table 6. The dietary recommendations emphasize consumption of fruits, vegetables, legumes, nuts, whole grain cereals, and fish. Trans fats should be < 1.0% and saturated fat < 10% (< 7% in presence of high cholesterol levels) of total energy. Regular physical exercise for at least 30 min/d should be encouraged. The guidelines recommend statin therapy up to the highest recommended or highest tolerable dose to reach lipid goals. Ezetimibe, bile acid sequestrants, or both combined should be considered for patients with statin intolerance. If the goal is not reached, a combination of a statin with a cholesterol absorption inhibitor or a bile acid sequestrant may be considered. A PCSK9 inhibitor may be considered for very high-risk patients with persistent high LDL-C despite treatment with the maximum tolerated statin dose in combination with ezetimibe or in patients with statin intolerance. CAnCER TREATMEnTS AnD CV TOxICITy The 2016 ESC Position Paper on cancer treatments and CV toxicity developed under the auspices of the ESC Committee for Practice Guidelines [Zamorano JL et al. Eur Heart J. 2016; Eur J Heart Fail. 2016] was presented by Patrizio Lancellotti, MD, University of Liege Hospital, Liege, Belgium, and Thomas Suter, MD, Bern University Hospital, Bern, Switzerland. Advances in oncology Table 6. Intervention Strategies Based on Total CV Risk and LDL-C Level Total CV risk (SCORE) % LDL-C levels < 70 mg/dL < 1.8 mmol/L 70 to < 100 mg/dL 1.8 to < 2.6 mmol/L 100 to < 155 mg/dL 2.6 to < 4.0 mmol/L 155 to < 190 mg/dL 4.0 to < 4.9 mmol/L ≥ 190 mg/dL ≥ 4.9 mmol/L <1 Lifestyle advice Lifestyle advice Lifestyle advice Lifestyle advice Lifestyle advice, consider drug if uncontrolled Class/Level I/C I/C I/C I/C IIa/A Lifestyle advice Lifestyle advice Lifestyle advice, consider drug if uncontrolled Lifestyle advice, consider drug if uncontrolled Lifestyle advice, consider drug if uncontrolled I/C I/C IIa/A IIa/A I/A Lifestyle advice Lifestyle advice, consider drug if uncontrolled Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most IIa/A IIa/A IIa/A I/A I/A Lifestyle advice, consider drug if uncontrolled Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most Lifestyle advice and drug treatment for most IIa/A IIa/A I/A I/A I/A ≥ 1 to < 5 Class/Level ≥ 5 to < 10 Class/Level ≥ 10 or very high-risk Class/Level CV, cardiovascular; LDL-C, low-density lipoprotein cholesterol; SCORE, Systematic Coronary Risk Estimation. Reprinted from Catapano AL et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw272. By permission of Oxford University Press on behalf of the European Society of Cardiology. Official Peer-Reviewed Highlights From ESC Congress 2016 7 http://www.escardio.org/365

Table of Contents for the Digital Edition of ESC Congress 2016