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SCOPE OF THE GUIDELINES

There are two major lipid guidelinesESC and the ACC/ AHA guidelines. The major differences are1. The scope of ACC/AHA is limited to randomized trials only, which excludes a significant body of data and promotes essentially a statin centric approach only. 2. The abolition of low-density lipoprotein cholesterol (LDL-C) targets in favour of specific statin regimens producing a 30–50% reduction in LDL-C may confuse many physicians and may compromise medication adherence. 3. The absence of target LDL-C levels in very high-risk patients may discourage clinicians to consider the addition of lipid modification treatments and individualize patient care. 4. A reduction in the threshold for treatment in primary prevention will result in a greater number of patients being prescribed statin therapy, which is potentially good in young patients with high life time risk, but will result in a very large number of older patients offered therapy. 5. The mixed pool risk calculator used to asses CVD risk in the guidelines for primary prevention has not been fully evaluated1.6. ESC/EAS guidelines provide guidance on elevated triglycerides (TG) including the relevance of identifying and treating secondary causes, recommending pharmacological intervention, if fasting TGs are >2.3 mmol/L, using fibrates. The ACC AHA guidelines don’t recommend any other drugs beside statins and deals with risks rather than goals. 7. The guideline doesn’t adequately address the management of the group who cannot tolerate recommended statin doses. But both the guidelines ESC and ACC/AHA identifies LDL as the most important risk factor and both recommend behavioural and lifestyle modifications concurrent to drug therapy.