%0 Journal Article
%A Ray, Kausik K.
%A Ference, Brian A.
%A Severin, Tania
%A Blom, Dirk
%A Nicholls, Stephen J.
%A Shiba, Mariko H.
%A Almahmeed, Wael
%A Alonso, Rodrigo
%A Daccord, Magdalena
%A Ezhov, Marat
%A Olmo, Rosa Fernandez
%A Jankowski, Piotr
%A Lanas, Fernando
%A Mehta, Roopa
%A Puri, Raman
%A Wong, Nathan D.
%A Wood, David
%A Zhao, Dong
%A Gidding, Samuel S.
%A Virani, Salim S.
%A Lloyd-Jones, Donald
%A Pinto, Fausto
%A Perel, Pablo
%A Santos, Raul D.
%T World Heart Federation Cholesterol Roadmap 2022
%D 2022
%@ 2211-8160
%U http://hdl.handle.net/10668/21657
%X Background: Atherosclerotic cardiovascular diseases (ASCVD) including myocardial infarction, stroke and peripheral arterial disease continue to be major causes of premature death, disability and healthcare expenditure globally. Preventing the accumulation of cholesterol-containing atherogenic lipoproteins in the vessel wall is central to any healthcare strategy to prevent ASCVD. Advances in current concepts about reducing cumulative exposure to apolipoprotein B (apo B) cholesterol-containing lipoproteins and the emergence of novel therapies provide new opportunities to better prevent ASCVD. The present update of the World Heart Federation Cholesterol Roadmap provides a conceptual framework for the development of national policies and health systems approaches, so that potential roadblocks to cholesterol management and thus ASCVD prevention can be overcome.Methods: Through a review of published guidelines and research papers since 2017, and consultation with a committee composed of experts in clinical management of dyslipidaemias and health systems research in low-and-middle income countries (LMICs), this Roadmap identifies (1) key principles to effective ASCVD prevention (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMICs; and (4) potential strategies for overcoming these.Results: Reducing the future burden of ASCVD will require diverse approaches throughout the life-course. These include: a greater focus on primordial prevention; availability of affordable cholesterol testing; availability of universal cholesterol screening for inherited dyslipidaemias; risk stratification moving beyond 10-year risk to look at lifetime risk with adequate risk estimators; wider availability of affordable cholesterol-lowering therapies which should include statins as essential medications globally; use of adequate doses of potent statin regimens; and combination therapies with ezetimibe or other therapies in order to attain and maintain robust reductions in LDL-C in those at highest risk. Continuing efforts are needed on health literacy for both the public and healthcare providers, utilising multi-disciplinary teams in healthcare and applications that quantify both ASCVD risk and benefits of treatment as well as increased adherence to therapies.Conclusions: The adverse effects of LDL-cholesterol and apo B containing lipoprotein exposure are cumulative and result in ASCVD. These are preventable by implementation of different strategies, aimed at efficiently tackling atherosclerosis at different stages throughout the human life-course. Preventive strategies should therefore be updated to implement health policy, lifestyle changes and when needed pharmacotherapies earlier with investment in, and a shift in focus towards, early preventive strategies that preserve cardiovascular health rather than treat the consequences of ASCVD.
%K cholesterol
%K low-density lipoprotein cholesterol prevention
%K ASCVD
%K lipid lowering therapy
%K familial hypercholesterolaemia
%K Cardiovascular-disease
%K Familial hypercholesterolemia
%K Ldl-cholesterol
%K Statin therapy
%K Risk-factors
%K Prevention
%K Management
%K Metaanalysis
%K Individuals
%K Evolocumab
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