Millán Núñez-Cortés Jesús, Pedro-Botet Juan, Brea-Hernando Ángel, Díaz-Rodríguez Ángel, González-Santos Pedro, Hernández-Mijares Antonio, Mantilla-Morató Teresa, Pintó-Sala Xavier, Simó Rafael
Servicio de Medicina Interna, Hospital Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
Unidad de Lípidos, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Rev Esp Cardiol (Engl Ed). 2014 Jan;67(1):36-44. doi: 10.1016/j.rec.2013.06.011. Epub 2013 Nov 8.
Although atherogenic dyslipidemia is a recognized cardiovascular risk factor, it is often underassessed and thus undertreated and poorly controlled in clinical practice. The objective of this study was to reach a multidisciplinary consensus for the establishment of a set of clinical recommendations on atherogenic dyslipidemia to optimize its prevention, early detection, diagnostic evaluation, therapeutic approach, and follow-up.
After a review of the scientific evidence, a scientific committee formulated 87 recommendations related to atherogenic dyslipidemia, which were grouped into 5 subject areas: general concepts (10 items), impact and epidemiology (4 items), cardiovascular risk (32 items), detection and diagnosis (19 items), and treatment (22 items). A 2-round modified Delphi method was conducted to compare the opinions of a panel of 65 specialists in cardiology (23%), endocrinology (24.6%), family medicine (27.7%), and internal medicine (24.6%) on these issues.
After the first round, the panel reached consensus on 65 of the 87 items discussed, and agreed on 76 items by the end of the second round. Insufficient consensus was reached on 3 items related to the detection and diagnosis of atherogenic dyslipidemia and 3 items related to the therapeutic goals to be achieved in these patients.
The external assessment conducted by experts on atherogenic dyslipidemia showed a high level of professional agreement with the proposed clinical recommendations. These recommendations represent a useful tool for improving the clinical management of patients with atherogenic dyslipidemia. A detailed analysis of the current scientific evidence is required for those statements that eluded consensus.
尽管致动脉粥样硬化性血脂异常是一种公认的心血管危险因素，但在临床实践中，它常常未得到充分评估，因此治疗不足且控制不佳。本研究的目的是达成多学科共识，以制定一套关于致动脉粥样硬化性血脂异常的临床建议，从而优化其预防、早期检测、诊断评估、治疗方法及随访。
在回顾科学证据后，一个科学委员会制定了87条与致动脉粥样硬化性血脂异常相关的建议，这些建议被归为5个主题领域：一般概念（10项）、影响与流行病学（4项）、心血管风险（32项）、检测与诊断（19项）以及治疗（22项）。采用两轮改良德尔菲法，比较了由65位心脏病学（23%）、内分泌学（24.6%）、家庭医学（27.7%）和内科（24.6%）专家组成的小组对这些问题的意见。
第一轮后，该小组对所讨论的87项中的65项达成了共识，第二轮结束时对76项达成了一致意见。在与致动脉粥样硬化性血脂异常检测和诊断相关的3项以及与这些患者要实现的治疗目标相关的3项上未达成充分共识。
专家对致动脉粥样硬化性血脂异常进行的外部评估显示，与所提出的临床建议高度专业一致。这些建议是改善致动脉粥样硬化性血脂异常患者临床管理的有用工具。对于未达成共识的陈述，需要对当前科学证据进行详细分析。
