ESC 2019 2019 ESC/EAS Guidelines for the management of dyslipidaemias
European Society of Cardiology｜循環器 / 脂質異常症｜78 ページ｜チャンク 828｜推奨 78 件｜current
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| 頁 | クラス | レベル | 推奨文 | 表 |
|---|---|---|---|---|
| p.17 | IIa | B | Arterial (carotid and/or femoral) plaque bur- den on arterial ultrasonography should be considered as a risk modifier in individuals at low or moderate risk.29,30 | |
| p.17 | IIb | B | CAC score assessment with CT may be considered as a risk modifier in the CV risk assess- ment of asymptomatic individuals at low or moderate risk.1416,24,26 | |
| p.17 | I | C | estimation Total risk estimation using a risk estimation system such as SCORE is recommended for asymptomatic adults >40 years of age without evidence of CVD, DM, CKD, familial hyper- cholesterolaemia, or LDL-C >4.9 mmol/L (>190 mg/dL). | |
| p.17 | I | C | It is recommended that high- and very-high- risk individuals are identified on the basis of documented CVD, DM, moderate-to-severe renal disease, very high levels of individual risk factors, FH, or a high SCORE risk. It is recommended that such patients are considered as a priority for advice and management of all risk | |
| p.17 | III | C | factors. Risk scores developed for the general population are not recommended for CV risk assess- ment in patients with DM or FH. 5 Lipids and lipoproteins | |
| p.21 | I | C | TC is to be used for the estimation of total CV risk by means of the SCORE system. | |
| p.21 | I | C | HDL-C analysis is recommended to further refine risk estimation using the online SCORE system. | |
| p.21 | I | C | LDL-C analysis is recommended as the primary lipid analysis method for screening, diagnosis, and management. | |
| p.21 | I | C | TG analysis is recommended as part of the routine lipid analysis process. | |
| p.22 | I | A | In secondary prevention for patients at very-high risk,c an LDL-C reduction of >_50% from baselined and an LDL-C goal of <1.4 mmol/L (<55 mg/dL) are recommended.3335,119,120 | |
| p.22 | I | C | an LDL-C goal of <1.4 mmol/L (<55 mg/dL) are recommended.3436 | |
| p.22 | I | A | recommended.34,35 | |
| p.22 | IIa | A | In individuals at moderate risk,c an LDL-C goal of <2.6 mmol/L (<100 mg/dL) should be considered.34 | |
| p.22 | IIb | A | In individuals at low risk,c an LDL-C goal <3.0 mmol/L (<116 mg/dL) may be considered.36 | |
| p.35 | I | A | It is recommended that a high-intensity statin is prescribed up to the highest tolerated dose to reach the goals set for the specific level of risk.32,34,38 | |
| p.35 | I | B | recommended.33 | |
| p.35 | I | A | ezetimibe, a combination with a PCSK9 inhibitor is recommended.119,120 | |
| p.35 | IIa | C | If a statin-based regimen is not tolerated at any dosage (even after rechallenge), ezetimibe should be considered.197,265,353 | |
| p.35 | IIb | C | may also be considered.197,265,353 | |
| p.35 | IIb | C | If the goalc is not achieved, statin combination with a bile acid sequestrant may be considered. | |
| p.38 | I | B | hypertriglyceridaemia Statin treatment is recommended as the first drug of choice to reduce CVD risk in high-risk individuals with hypertriglyceridaemia [TG levels >2.3 mmol/L (>200 mg/dL)].355 | |
| p.38 | IIa | B | In high-risk (or above) patients with TG levels between 1.55.6 mmol/L (135499 mg/dL) despite statin treatment, n-3 PUFAs (icosapent ethyl 22 g/day) should be considered in combination with a statin.194 | |
| p.38 | IIb | B | In primary prevention patients who are at LDL-C goal with TG levels >2.3 mmol/L (>200 mg/dL), fenofibrate or bezafibrate may be considered in combination with statins.305307,356 | |
| p.38 | IIb | C | In high-risk patients who are at LDL-C goal with TG levels >2.3 mmol/L (>200 mg/dL), fenofibrate or bezafibrate may be considered in combination with statins.305307,356 | |
| p.40 | I | C | It is recommended that a diagnosis of FH is considered in patients with CHD aged <55 years for men and <60 years for women, in people with relatives with premature fatal or non-fatal CVD, in people with relatives who have tendon xanthomas, in people with severely elevated LDL-C [in adults >5 mmol/L (>190 mg/dL), in children >4 mmol/L (>150 mg/dL)], and in first-degree relatives of FH | |
| p.40 | I | C | patients. It is recommended that FH should be diagnosed using clinical criteria and confirmed, when possible, via DNA analysis. | |
| p.40 | I | C | Once the index case is diagnosed, family cas- cade screening is recommended. It is recommended that FH patients with | |
| p.40 | I | C | ASCVD or who have another major risk fac- tor are treated as very-high-risk, and that those with no prior ASCVD or other risk fac- tors are treated as high-risk. | |
| p.40 | I | C | For FH patients with ASCVD who are at very- high risk, treatment to achieve a >_50% reduction from baseline and an LDL-C <1.4 mmol/L (<55 mg/dL) is recommended. If goals cannot be achieved, a drug combination is recommended. | |
| p.40 | IIa | C | In primary prevention, for individuals with FH at very-high risk, an LDL-C reduction of >_50% from baseline and an LDL-C goal of <1.4 mmol/L (<55 mg/dL) should be considered. | |
| p.40 | I | C | Treatment with a PCSK9 inhibitor is recom- mended in very-high-risk FH patients if the treatment goal is not achieved on maximal tol- erated statin plus ezetimibe. | |
| p.40 | I | C | In children, testing for FH is recommended from the age of 5 years, or earlier if HoFH is suspected. | |
| p.40 | IIa | C | Children with FH should be educated to adopt a proper diet and treated with a statin from 810 years of age. Goals for treatment should be LDL-C <3.5 mmol/L (<135 mg/dL) at >10 years of age. | |
| p.43 | I | A | Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients.217 | |
| p.43 | I | A | Treatment with statins is recommended for primary prevention, according to the level of risk, in older people aged <_75 years.217 | |
| p.43 | IIb | B | Initiation of statin treatment for primary prevention in older people aged >75 years may be considered, if at high-risk or above.217 | |
| p.45 | I | A | Statins are recommended in patients with T1DM who are at high or very-high risk.c 427 | |
| p.45 | IIa | B | with ezetimibe should be considered.33,299 | |
| p.45 | I | A | in diabetes mellitus In patients with T2DM at very-high riskc, an LDL-C reduction of >_50% from baseline and an LDL-C goal of <1.4 mmol/L (<55 mg/dL) is recommended.34,418,432 | |
| p.45 | I | A | In patients with T2DM at high risk,c an LDL-C reduction of >_50% from baseline and an LDL- C goal of <1.8 mmol/L (<70 mg/dL) is recommended.418 | |
| p.45 | IIa | C | Intensification of statin therapy should be con- sidered before the introduction of combina- tion therapy. If the goal is not reached, statin combination | |
| p.45 | III | C | Statin therapy is not recommended in pre- menopausal patients with diabetes who are considering pregnancy or are not using adequate contraception. | |
| p.45 | IIb | C | Statin therapy may be considered in both T1DM and T2DM patients aged <_30 years with evidence of end organ damage and/or an LDL-C level >2.5 mmol/L, as long as pregnancy is not being planned. | |
| p.47 | I | A | In all ACS patients without any contraindica- tion or definite history of intolerance, it is recommended that high-dose statin therapy is initiated or continued as early as possible, regardless of initial LDL-C values.438,440,442 | |
| p.47 | IIa | C | Lipid levels should be re-evaluated 46 weeks after ACS to determine whether a reduction of >_50% from baseline and goal levels of LDL- C <1.4 mmol/L (<55 mg/dL) have been achieved. Safety issues need to be assessed at this time and statin treatment doses adapted accordingly. | |
| p.47 | I | B | If the LDL-C goal is not achieved after 46 weeks with the maximally tolerated statin dose, combination with ezetimibe is recommended.33 | |
| p.47 | I | B | If the LDL-C goal is not achieved after 46 weeks despite maximal tolerated statin therapy and ezetimibe, the addition of a PCSK9 inhibitor is recommended.119,120 | |
| p.47 | IIa | C | In patients with confirmed statin intolerance or in patients in whom a statin is contraindicated, ezetimibe should be considered. For patients who present with an ACS and | |
| p.47 | IIa | C | whose LDL-C levels are not at goal, despite already taking a maximally tolerated statin dose and ezetimibe, the addition of a PCSK9 inhibitor early after the event (during hospitalization for the ACS event if possible) should be considered. | |
| p.47 | IIa | B | Routine pre-treatment or loading (on a back- ground of chronic therapy) with a high-dose statin should be considered in patients under- going PCI for an ACS or elective PCI.443,454,456 | |
| p.48 | I | A | Patients with a history of ischaemic stroke or TIA are at very high-risk of ASCVD, particularly recurrent ischaemic stroke, so it is rec- ommended that they receive intensive LDL-C- lowering therapy.459,460 | |
| p.49 | III | A | Initiation of lipid-lowering therapy is not rec- ommended in patients with HF in the absence of other indications for their use.466,470 | |
| p.49 | III | A | Initiation of lipid-lowering treatment in patients with aortic valvular stenosis without CAD to slow progression of aortic valve stenosis in the absence of other indications for their use is not recommended.266,479481 CAD = coronary artery disease; HF = heart failure. aClass of recommendation. bLevel of evidence. | |
| p.49 | I | A | It is recommended that patients with Kidney Disease Outcomes Quality Initiative stage 35c CKD are considered to be at high or very-high risk of ASCVD.489493 | |
| p.49 | I | A | The use of statins or statin/ezetimibe combina- tion is recommended in patients with non-dialysis-dependent stage 35 CKD.214,222,495,496 | |
| p.49 | IIa | C | In patients already on statins, ezetimibe, or a sta- tin/ezetimibe combination at the time of dialysis initiation, continuation of these drugs should be considered, particularly in patients with ASCVD. | |
| p.49 | III | A | In patients with dialysis-dependent CKD who are free of ASCVD, commencement of statin therapy is not recommended.220,221 | |
| p.50 | IIa | B | in solid organ transplant patients Statins should be considered as first-line agents in transplant patients. Initiation should be at low doses with careful uptitration and with caution regarding potential drugdrug interactions, partic- ularly for patients on ciclosporin.507 | |
| p.50 | IIb | C | In patients who are intolerant of statins or those with significant dyslipidaemia despite maximally tolerated statin treatment, alternative or additional therapy with ezetimibe may be considered. aClass of recommendation. bLevel of evidence. | |
| p.51 | I | A | In patients with PAD, lipid-lowering therapy, including a maximum tolerated dose of statin, plus ezetimibe or a combination with a PCSK9 inhibitor if needed, is recommended to reduce the risk of ASCVD events.512,524 | |
| p.58 | III | C | Risk scores developed for the general population are not recommended for CV risk assessment in patients with DM or FH. | |
| p.58 | I | C | TC is to be used for the estimation of total CV risk by means of the SCORE system. | |
| p.58 | I | C | HDL-C analysis is recommended to further refine risk estimation using the online SCORE system. | |
| p.58 | I | C | LDL-C analysis is recommended as the primary lipid analysis method for screening, diagnosis, and management. | |
| p.58 | I | C | TG analysis is recommended as a part of the routine lipid analysis approach. | |
| p.58 | I | B | If the goals are not achieved with the maximum tolerated dose of a statin, combination with ezetimibe is recommended. | |
| p.58 | I | C | It is recommended that FH is diagnosed using clinical criteria and confirmed, when possible, with DNA analysis. | |
| p.58 | I | C | Once the index case is diagnosed, family cascade screening is recommended. | |
| p.59 | I | C | In children, testing for FH is recommended from the age of 5 years, or earlier if HoFH is suspected. | |
| p.59 | I | A | Treatment with statins is recommended for older people with ASCVD in the same way as for younger patients. | |
| p.59 | I | A | Treatment with statins is recommended for primary prevention, according to the level of risk, in older people aged <_75 years. | |
| p.59 | I | A | Statins are recommended in patients with T1DM who are at high or very-high risk.c | |
| p.59 | III | A | Initiation of lipid-lowering therapy is not recommended in patients with HF in the absence of other indications for their use. | |
| p.59 | I | A | It is recommended that patients with stage 35 CKD are considered to be at high or very-high risk of ASCVD. | |
| p.59 | I | A | The use of statins or statin/ezetimibe combination is recommended in patients with non-dialysis-dependent stage 35 CKD. | |
| p.59 | III | A | In patients with dialysis-dependent CKD who are free of ASCVD, commencement of statin therapy is not recommended. | |
| p.59 | III | C | The use of lipid-lowering drugs only on the basis of the presence of CIID is not recommended. | |
| p.59 | I | C | It is recommended that SMIs are used as modifiers for estimating total ASCVD risk. |