Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
Nephrologist and Professor in the Department of Medicine and Dentistry at the University of Alberta.
Can Fam Physician. 2023 Oct;69(10):675-686. doi: 10.46747/cfp.6910675.
To update the 2015 clinical practice guideline and provide a simplified approach to lipid management in the prevention of cardiovascular disease (CVD) for primary care.
Following the Institute of Medicine's , a multidisciplinary, pan-Canadian guideline panel was formed. This panel was represented by primary care providers, free from conflicts of interest with industry, and included the patient perspective. A separate scientific evidence team performed evidence reviews on statins, ezetimibe, proprotein convertase subtilisin-kexin type 9 inhibitors, fibrates, bile acid sequestrants, niacin, and omega-3 supplements (docosahexaenoic acid with eicosapentaenoic acid [EPA] or EPA ethyl ester alone [icosapent]), as well as on 11 supplemental questions. Recommendations were finalized by the guideline panel through use of the Grading of Recommendations Assessment, Development and Evaluation methodology.
All recommendations are presented in a patient-centred manner designed with the needs of family physicians and other primary care providers in mind. Many recommendations are similar to those published in 2015. Statins remain first-line therapy for both primary and secondary CVD prevention, and the Mediterranean diet and physical activity are recommended to reduce cardiovascular risk (primary and secondary prevention). The guideline panel recommended against using lipoprotein a, apolipoprotein B, or coronary artery calcium levels when assessing cardiovascular risk, and recommended against targeting specific lipid levels. The team also reviewed new evidence pertaining to omega-3 fatty acids (including EPA ethyl ester [icosapent]) and proprotein convertase subtilisin-kexin type 9 inhibitors, and outlined when to engage in informed shared decision making with patients on interventions to lower cardiovascular risk.
These updated evidence-based guidelines provide a simplified approach to lipid management for the prevention and management of CVD. These guidelines were created by and for primary health care professionals and their patients.
更新 2015 年临床实践指南，为初级保健提供一种简化的心血管疾病（CVD）预防脂质管理方法。
遵循美国医学研究所的方法，成立了一个多学科、全加拿大的指南小组。该小组由初级保健提供者组成，与行业没有利益冲突，并包括患者的观点。一个独立的科学证据小组对他汀类药物、依折麦布、前蛋白转化酶枯草溶菌素 9 抑制剂、贝特类药物、胆汁酸螯合剂、烟酸和 ω-3 补充剂（二十二碳六烯酸与二十碳五烯酸[EPA]或 EPA 乙酯单独[icosapent]）进行了证据审查，以及对 11 个补充问题进行了审查。指南小组通过使用推荐评估、制定和评估分级方法最终确定了建议。
所有建议均以患者为中心的方式呈现，旨在满足家庭医生和其他初级保健提供者的需求。许多建议与 2015 年发布的建议相似。他汀类药物仍然是原发性和继发性 CVD 预防的一线治疗药物，建议地中海饮食和体育活动以降低心血管风险（原发性和继发性预防）。指南小组建议在评估心血管风险时不使用脂蛋白 a、载脂蛋白 B 或冠状动脉钙水平，也不建议针对特定的血脂水平。该小组还审查了与 ω-3 脂肪酸（包括 EPA 乙酯[icosapent]）和前蛋白转化酶枯草溶菌素 9 抑制剂相关的新证据，并概述了何时与患者进行知情的共同决策，以降低心血管风险。
这些更新的循证指南为 CVD 的预防和管理提供了一种简化的脂质管理方法。这些指南是由初级保健专业人员及其患者创建的。
