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. 2017 May;19(Suppl D):D3-D54.
doi: 10.1093/eurheartj/sux029. Epub 2017 May 2.

ANMCO/ISS/AMD/ANCE/ARCA/FADOI/GICR-IACPR/SICI-GISE/SIBioC/SIC/SICOA/SID/SIF/SIMEU/SIMG/SIMI/SISA Joint Consensus Document on cholesterol and cardiovascular risk: diagnostic-therapeutic pathway in Italy

Michele Massimo Gulizia  1   2 , Furio Colivicchi  1 , Gualtiero Ricciardi  3 , Simona Giampaoli  3 , Aldo Pietro Maggioni  4 , Maurizio Averna  5 , Maria Stella Graziani  6 , Ferruccio Ceriotti  6 , Alessandro Mugelli  7 , Francesco Rossi  7 , Gerardo Medea  8 , Damiano Parretti  8 , Maurizio Giuseppe Abrignani  1 , Marcello Arca  5 , Pasquale Perrone Filardi  9 , Francesco Perticone  10 , Alberico Catapano  5 , Raffaele Griffo  11 , Federico Nardi  1 , Carmine Riccio  1 , Andrea Di Lenarda  1 , Marino Scherillo  1 , Nicoletta Musacchio  12 , Antonio Vittorio Panno  13 , Giovanni Battista Zito  14 , Mauro Campanini  15 , Leonardo Bolognese  16 , Pompilio Massimo Faggiano  17 , Giuseppe Musumeci  17 , Enrico Pusineri  18 , Marcello Ciaccio  6 , Enzo Bonora  19 , Giorgio Cantelli Forti  7 , Maria Pia Ruggieri  20 , Claudio Cricelli  8 , Francesco Romeo  9 , Roberto Ferrari  9 , Attilio Maseri  21
Affiliations

ANMCO/ISS/AMD/ANCE/ARCA/FADOI/GICR-IACPR/SICI-GISE/SIBioC/SIC/SICOA/SID/SIF/SIMEU/SIMG/SIMI/SISA Joint Consensus Document on cholesterol and cardiovascular risk: diagnostic-therapeutic pathway in Italy

Michele Massimo Gulizia et al. Eur Heart J Suppl. 2017 May.

Abstract

Atherosclerotic cardiovascular disease still represents the leading cause of death in Western countries. A wealth of scientific evidence demonstrates that increased blood cholesterol levels have a major impact on the outbreak and progression of atherosclerotic plaques. Moreover, several cholesterol-lowering pharmacological agents, including statins and ezetimibe, have proved effective in improving clinical outcomes. This document focuses on the clinical management of hypercholesterolaemia and has been conceived by 16 Italian medical associations with the support of the Italian National Institute of Health. The authors discuss in detail the role of hypercholesterolaemia in the genesis of atherosclerotic cardiovascular disease. In addition, the implications for high cholesterol levels in the definition of the individual cardiovascular risk profile have been carefully analysed, while all available therapeutic options for blood cholesterol reduction and cardiovascular risk mitigation have been explored. Finally, this document outlines the diagnostic and therapeutic pathways for the clinical management of patients with hypercholesterolaemia.

Keywords: Atherosclerosis; Diagnostic and therapeutic pathways; Hypercholesterolaemia; PCSK9 inhibitors; Statins; Sustainable health care.

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Figures

Figure 1
Figure 1
Algorithms for National Health Service prescription of statins in compliance with AIFA note number 13.
Figure 2
Figure 2
Patients receiving secondary cardiovascular prevention interventions.
Figure 3
Figure 3
Patients with diabetes mellitus.
Figure 4
Figure 4
Patients with chronic kidney disease.
Figure 5
Figure 5
Patients with familial dyslipidaemia.
Figure 6
Figure 6
Diagram for the comparative assessment of the LDL cholesterol reduction rate. Adapted from NHS Foundation Trust.
Figure 7
Figure 7
Relationship between reduction in LDL cholesterol (C-LDL) levels and the reduction in the relative risk of ischaemic cardiovascular events. Modified from Baigent et al.
Figure 8
Figure 8
Diagnostic and therapeutic pathways in patients with statin-induced myopathy. ULN, upper limit of normal.
Figure 9
Figure 9
Diagnostic and therapeutic pathways in patients with statin-induced liver injury. ULN, upper limit of normal.
Figure 10
Figure 10
Mechanism of action of lomitapide and mipomersen. Lomitapide blocks the synthesis of lipoproteins containing apolipoprotein B (ApoB) by inhibiting the triglyceride microsomal transfer protein (MTP), the protein responsible for the transfer of triglycerides (TGs), phospholipids, and cholesterol esters to the ApoB in the endoplasmic reticulum; mipomersen is an antisense oligonucleotide that reduces the hepatic secretion of VLDL by binding messenger RNA encoding ApoB and preventing its transcription. Reproduced from Ahn and Choi.
Figure 11
Figure 11
(A) PCSK9 function. (B) effects mediated by PCSK9 inhibitor therapy. Reproduced from Do et al.
Figure 12
Figure 12
Mean annual cost of diabetic patients with acute coronary syndrome (ACS) incurred by the National Health Service. CV, cardiovascular.
See this image and copyright information in PMC

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