Harmonized Lipoprotein Management Goals
Over the past two decades, various expert organizations have issued multiple cardiometabolic risk management guidelines/recommendations. Some guidelines focus on overall cardiovascular risk, while others address risk in special populations such as diabetes, pre-diabetes, or familial hypercholesterolemia.
All of these recommendations share the perspective that the higher an individual’s risk, the lower the atherogenic lipid/lipoprotein goals (LDL-C, Non-HDL-C, ApoB) needed to mitigate that risk.
However, individual recommendations differ in the criteria used to identify risk groups (moderate, high, very high, extreme) and the specific lipid/lipoprotein goals for each risk group. These differences have complicated the evaluation and management of cardiometabolic risk.
Recently, attempts have been made to harmonize atherogenic lipid/lipoprotein goals. For each risk group, “threshold goals” are advocated that define the minimally acceptable reduction in atherogenic lipid/lipoprotein values needed to reduce heart attack and stroke risk. These threshold goals represent the lower of two values – a percent reduction or an absolute value for atherogenic lipids/lipoproteins specific to an individual’s risk group. Due to greater clinical benefit with more aggressive LDL/ApoB reduction, individuals are advised to maintain values well below the threshold goal for their risk group.
Example of the Personalized Lipoprotein Management Goals as reported in a Cardiometabolic Risk Assessment
We embrace this harmonization and have modified the Cardiometabolic Risk Report to reflect a simplified threshold goal for individuals in each risk group. Where recommendations continue to differ, we have selected the more aggressive goals advocated that align with an individual’s specific population and level of risk.
References:
Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal 2019;41:111-88.
Lloyd-Jones D, Morris P, et al. 2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk. J Am Coll Cardiol. 2022;80(14):1366–1418.
Handelsman Y, Anderson JE, et al. DCRM Multispecialty Practice Recommendations for the management of diabetes, cardiorenal, and metabolic diseases. J Diabetes Complications. 2022 Feb;36(2):108101.