Management Guidelines

2003 European Guidelines: Guide to lipid management in asymptomatic subjects

The prevention of CHD in patients with established CHD or other atherosclerotic disease, and in asymptomatic healthy prevention actions should be guided in accordance with the total CVD risk level. Most recently, the Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice¹ has provided guidelines using a simplified risk analysis chart, the SCORE (Systemic Coronary Risk Evaluation) system, which includes factors such as age, gender, smoking, total cholesterol or the total cholesterol/HDL ratio and systolic blood pressure. There are now two charts, a low-risk chart used in Belgium, France, Greece, Italy, Luxembourg, Spain, Switzerland and Portugal and a high-risk chart used in all other European countries. The SCORE system provides a risk assessment for the probability of a fatal CVD event over 10 years.

With respect to blood lipids, recommended treatment goals include a total cholesterol consistently below 5.0 mmol/L (190 mg/dL) and an LDL-C below 3.0 mmol/L (115 mg/dL). For patients with clinically established CVD and patients with diabetes the treatment goals should be lower: total cholesterol <4.5 mmol/L (175 mg/dL) and LDL-C <2.5 mmol/L (100 mg/dL). If lifestyle changes fail to reach these goals, drug therapy should be initiated.

Concentrations of HDL-C and triglycerides are not used as goals of therapy. However, an HDL-C <1.0 mmol/L (40 mg/dL) in men and <1.2 mmol/L (46 mg/dL) in women, and fasting triglycerides >1.7 mmol/L (150 mg/dL) are markers of increased coronary risk.

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*Adapted from Eur Heart J 2003;24:1601–1610, with permission from The European Society of Cardiology.

Reference:
1. De Backer G, Ambrosioni E, Borch-Johnsen K et al. Eur Heart J 2003;24:1601–1610.

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