Primary prevention of CVD: treating dyslipidaemia.

INTRODUCTION

The incidence of dyslipidaemia is high: in 2000, approximately 25% of adults in the USA had total cholesterol greater than 6.2 mmol/L or were taking lipid-lowering medication. Primary prevention in this context is defined as long-term management of people at increased risk but with no clinically overt evidence of CVD - such as acute MI, angina, stroke, and PVD - and who have not undergone revascularisation.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of pharmacological cholesterol-lowering interventions in people at low risk (less than 0.6% annual CHD risk); at medium risk (0.6-1.4% annual CHD risk); and at high risk (at least 1.5% annual CHD risk)? What are the effects of reduced or modified fat diet? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: ezetimibe, fibrates, niacin (nicotinic acid), reduced- or modified-fat diet, resins, and statins.