Update: Brazilian Guideline of Dyslipidemia and Atherosclerosis Prevention

In early August 2017, the Brazilian Society of Cardiology released an update of the Guidelines of Dyslipidemia and Atherosclerosis Prevention published in 2013. In this new document there are modifications in the reference values ​​for plasma lipoproteins, a new way to stratify the cardiovascular risk and the therapeutic goals and novelties on non-pharmacological treatment.

Here are listed the most important updates for adults (pharmacological treatment is not included).

• Fasting (Degree of Recommendation: IIa; Level of Evidence: C).

Fasting is no longer required in the dosage of the complete lipid profile. It is recommended the maintenance of a stable metabolic status and the usual diet, since the values ​​of cholesterol and plasma lipoproteins (HDL-c, not HDL-c and LDL-c) are not influenced by food status.

Fasting is necessary only for a further confirmation test if the triglyceride dosage is elevated (> 440mg/dL) without fasting.

• Cardiovascular risk stratification

In many cases the acute coronary event is the first manifestation of atherosclerotic disease. Therefore, its necessary identify asymptomatic individuals for primary prevention, with a correct definition of individual therapeutic goals.

To estimate the risk this update recommends the use of the Global Risk Score.

Look the new stratification at the figure below.

Figure 1. Cardiovascular risk stratification based on risk factors and the Global Risk Score. Adapted from the Brazilian Guideline of Dyslipidemia and Atherosclerosis Prevention. SBC, 2017.

• Reference values ​​and therapeutic target according to cardiovascular risk. (Degree of Recommendation: IIa, Level of Evidence: C)

The target values ​​to LDL-c and non-HDL-c have differences according to cardiovascular risk stratification, more restricted in this update.

Recent clinical trials have shown that more intense reductions in LDL-c is associated with important benefits in reducing cardiovascular events and mortality.

Compared to the previous Guideline, there was a reduction in the desirable values ​​for cholesterol, the values ​​for triglycerides were maintained, the "very high risk" stratification was included accompanied to low target values to LDL-c

Observe the current recommendations in the table below.

Figure 2. Reference values ​​and therapeutic target of lipid profile for adults. Extracted from the Brazilian Guideline of Dyslipidemia and Atherosclerosis Prevention. SBC, 2017.

• Dietary management

This guideline recommends trans fatty acid-free diet, an intake of <10% of the total caloric value of saturated fatty acids for healthy subjects and less than <7% of the total caloric value for those with increased cardiovascular risk.

Recent studies have reinforced that trans fatty acids increase the LDL-c plasma concentration and induce an intense atherosclerotic lesion.

For cholesterol, recent studies have shown insufficient evidence to establish a cutoff value for consumption.

See other recommendations:

Figure 3. Dietary recommendations in the management of cardiovascular disease.

This update reinforces the importance of moderate amounts of fat in the diet, trans fatty acids elimination, a strict control of saturated fat intake, prioritizing polyunsaturated fats and monounsaturated fats, reduced amounts of sugars, and the consuming of lean meats, fruits, grains, and vegetables.

• Physical activity (Grade of Recommendation: I; Level of Evidence: A)

Physical activity has accumulated evidences over the years as an important role in the prevention and treatment of CVD, improving the vascular structure and function. The recommendation of physical activity has been maintained in this update.

Check out the full publication in our library.

It’s important highlight that each country has its own guideline adapted to its population.

To understand properly the health, the prevention and the adequate treatment you have to seek qualified healthcare professionals.

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Faludi AA, Izar MCO, Saraiva JFK, Chacra APM, Bianco HT, Afiune Neto A et al. Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017. Arq Bras Cardiol 2017; 109(2Supl.1):1-76

Xavier H. T., Izar M. C., Faria Neto J. R., Assad M. H., Rocha V. Z., Sposito A. C., Fonseca F. A., dos Santos J. E., Santos R. D., Bertolami M. C., Faludi A. A., Martinez T. L. R., Diament J., Guimarães A., Forti N. A., Moriguchi E., Chagas A. C. P., Coelho O. R., Ramires J. A. F.; Sociedade Brasileira de Cardiologia. V Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose. Arq Bras Cardiol 2013