PEER simplified lipid guideline 2023 update: Prevention and management of cardiovascular disease in primary care

Michael R Kolber¹, Scott Klarenbach², Michel Cauchon³, Mike Cotterill⁴, Loren Regier⁵, Raelene D Marceau⁶, Norah Duggan⁷, Rebecca Whitley⁸, Alex S Halme⁹, Tanis Poshtar¹⁰, G Michael Allan¹¹, Christina S Korownyk¹², Joey Ton¹³, Liesbeth Froentjes¹⁴, Samantha S Moe¹⁵, Danielle Perry¹⁶, Betsy S Thomas¹⁶, James P McCormack¹⁷, Jamie Falk¹⁸, Nicolas Dugré¹⁹, Scott R Garrison¹², Jessica E M Kirkwood²⁰, Jennifer Young²¹, Émélie Braschi²², Allison Paige²³, Jen Potter²³, Justin Weresch²⁴, Adrienne J Lindblad²⁵

Affiliations

¹ Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
² Nephrologist and Professor in the Department of Medicine and Dentistry at the University of Alberta.
³ Professor in the Département de médecine familiale et d'urgence at Université Laval in Québec City, Que.
⁴ Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine University based in Wawa.
⁵ Consulting Editor for the RxFiles Academic Detailing Program at the University of Saskatchewan in Saskatoon.
⁶ Assistant Professor in the School of Nursing at the University of Northern British Columbia in Prince George.
⁷ Associate Professor in the Department of Family Medicine at Memorial University of Newfoundland in St John's.
⁸ Assistant Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.
⁹ Internist-geriatrician at CISSS Montérégie-est (Hôpital Pierre-Boucher) and CISSS de la Gaspésie in Quebec.
¹⁰ Patient in Edmonton.
¹¹ Director of Programs and Practice Support at the College of Family Physicians of Canada (CFPC).
¹² Professor in the Department of Family Medicine at the University of Alberta.
¹³ Program Manager of Programs and Practice Support at the CFPC.
¹⁴ Research assistant in the Department of Family Medicine at the University of Alberta.
¹⁵ Clinical Evidence Expert for the CFPC.
¹⁶ Clinical Evidence Expert for the CFPC and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
¹⁷ Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.
¹⁸ Pharmacist and Associate Professor in the College of Pharmacy at the University of Manitoba.
¹⁹ Pharmacist at the CIUSSS du Nord-de-l'Île-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montréal in Quebec.
²⁰ Family physician and Assistant Professor in the Department of Family Medicine at the University of Alberta.
²¹ Family physician practising in Collingwood, Ont.
²² Hospitalist at the Élisabeth Bruyère Hospital in Ottawa, Ont, and a physician adviser at the CFPC.
²³ Assistant Professor in the Department of Family Medicine at the University of Manitoba.
²⁴ Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
²⁵ Clinical Evidence Expert Lead for the CFPC and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

PMID: 37833089
PMCID: PMC10575658
DOI: 10.46747/cfp.6910675

PEER simplified lipid guideline 2023 update: Prevention and management of cardiovascular disease in primary care

Michael R Kolber et al. Can Fam Physician. 2023 Oct.

. 2023 Oct;69(10):675-686.

doi: 10.46747/cfp.6910675.

Authors

Affiliations

¹ Professor in the Department of Family Medicine at the University of Alberta in Edmonton.
² Nephrologist and Professor in the Department of Medicine and Dentistry at the University of Alberta.
³ Professor in the Département de médecine familiale et d'urgence at Université Laval in Québec City, Que.
⁴ Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine University based in Wawa.
⁵ Consulting Editor for the RxFiles Academic Detailing Program at the University of Saskatchewan in Saskatoon.
⁶ Assistant Professor in the School of Nursing at the University of Northern British Columbia in Prince George.
⁷ Associate Professor in the Department of Family Medicine at Memorial University of Newfoundland in St John's.
⁸ Assistant Professor in the Department of Family Medicine at the University of Manitoba in Winnipeg.
⁹ Internist-geriatrician at CISSS Montérégie-est (Hôpital Pierre-Boucher) and CISSS de la Gaspésie in Quebec.
¹⁰ Patient in Edmonton.
¹¹ Director of Programs and Practice Support at the College of Family Physicians of Canada (CFPC).
¹² Professor in the Department of Family Medicine at the University of Alberta.
¹³ Program Manager of Programs and Practice Support at the CFPC.
¹⁴ Research assistant in the Department of Family Medicine at the University of Alberta.
¹⁵ Clinical Evidence Expert for the CFPC.
¹⁶ Clinical Evidence Expert for the CFPC and Assistant Adjunct Professor in the Department of Family Medicine at the University of Alberta.
¹⁷ Professor in the Faculty of Pharmaceutical Sciences at the University of British Columbia in Vancouver.
¹⁸ Pharmacist and Associate Professor in the College of Pharmacy at the University of Manitoba.
¹⁹ Pharmacist at the CIUSSS du Nord-de-l'Île-de-Montréal and Clinical Associate Professor in the Faculty of Pharmacy at the University of Montréal in Quebec.
²⁰ Family physician and Assistant Professor in the Department of Family Medicine at the University of Alberta.
²¹ Family physician practising in Collingwood, Ont.
²² Hospitalist at the Élisabeth Bruyère Hospital in Ottawa, Ont, and a physician adviser at the CFPC.
²³ Assistant Professor in the Department of Family Medicine at the University of Manitoba.
²⁴ Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont.
²⁵ Clinical Evidence Expert Lead for the CFPC and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta.

PMID: 37833089
PMCID: PMC10575658
DOI: 10.46747/cfp.6910675

Abstract

Objective: 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.

Methods: Following the Institute of Medicine's Clinical Practice Guidelines We Can Trust, 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.

Recommendations: 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.

Conclusion: 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.

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Figures

**Figure 1.**
PEER simplified lipid guideline 2023 summary

See this image and copyright information in PMC

Comment in

Response.
Kolber MR, Lindblad AJ, Klarenbach S, Allan GM. Kolber MR, et al. Can Fam Physician. 2024 Jun;70(6):371. doi: 10.46747/cfp.7006371_1. Can Fam Physician. 2024. PMID: 38886080 Free PMC article. No abstract available.
Repeat lipid testing.
Aubrey-Bassler K. Aubrey-Bassler K. Can Fam Physician. 2024 Jun;70(6):371. doi: 10.46747/cfp.7006371. Can Fam Physician. 2024. PMID: 38886085 Free PMC article. No abstract available.

References

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PEER simplified lipid guideline 2023 update: Prevention and management of cardiovascular disease in primary care

Affiliations

PEER simplified lipid guideline 2023 update: Prevention and management of cardiovascular disease in primary care

Authors

Affiliations

Abstract

Figures

Comment in

References

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Research Materials