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How to improve treatment guidelines for dyslipidemia?Lifestyle correction, early use of strong medications recommended at forum
  • By Kim Yun-mi
  • Published 2019.04.22 14:50
  • Updated 2019.04.22 14:50
  • comments 0

Dyslipidemia specialists have called for the Korean treatment guidelines on abnormal lipid levels in the blood to put more emphasis on improving lifestyles and using aggressive therapies at an early stage.

The Korean Society of Lipid & Atherosclerosis (KSoLA) held “the debate on new lipid guidelines” at its spring cardiovascular integrated conference held at BEXCO, Busan, Saturday, where experts discussed how to improve treatment guidelines.

Panelist physicians share their opinions on new lipid guidelines in the spring cardiovascular integrated conference, hosted by the Korean Society of Lipid & Atherosclerosis, at BEXCO, Busan, Saturday.

Panelist Cho Hong-keun, head physician of Yonsei Cho Hong-Keun Internal Medicine, said Korean physicians often miss out talking with patients while American College of Cardiology/American Heart Association (ACC/AHA) guideline states that a doctor-patient discussion is essential.

He cited as an example an outpatient with 320mg/dL total cholesterol and 240mg/dL LDL-C.

“Doctors regard patients with LDL-C over 190mg/dL as a high-risk group no matter what, and administer the drug even without any other risk factors or old age,” Cho said. “They have probably never lowered such high level of cholesterol through the diet. Most of them usually prescribe statin because they comply with the guidelines very well, but there is room for improvement.”

In revising the next treatment guidelines, the society should tell individual clinic owners to emphasize lifestyle correction when consulting for patients with high cholesterol, he added.

“If a patient is young and has no other cardiovascular risks, the physician should talk with the patient more to observe lifestyles and seek lifestyle improvement to reduce cholesterol even when his or her cholesterol is high,” Cho said.

Lee Byung-wan, a professor at the Endocrinology and Metabolism Department of Severance Hospital, said the nation would become a super-aged society in a decade, mentioning that Koreans aged at 65 or more already account for over 15 percent of the total population.

“Rather than making the treatment guidelines based on markers or imagine values, it would be better to reflect population characteristics such as aging,” he said.

Another expert stressed the need for an active and strong medication for the first and second prevention of cardiovascular disease.

Yoon Chang-hwan, a professor at Cardiology and Internal Medicine at Seoul National University Bundang Hospital, said he was often seeing ultra-high-risk patients whose arteriosclerosis has progressed significantly. “I try to use a strong statin therapy from the first place before a patient’s condition worsens, to reduce LDL-C a lot,” he said.

Professor Park Jae-hyung of Cardiovascular Internal Medicine at Korea University Anam Hospital pointed out that an early, aggressive treatment could guarantee an improvement in long-term cardiovascular mortality and the overall mortality.

Yoon also questioned why the local guidelines recommended PCSK9 inhibitors as “Class IIb,” although PCSK9 inhibitors showed excellent outcomes in lipid lowering.

Class IIb drugs are those whose evidence or convenience is not trusted, but usefulness is high or normal in clinical use.

Panelist physicians share their opinions on new lipid guidelines in the spring cardiovascular integrated conference, hosted by the Korean Society of Lipid & Atherosclerosis, at BEXCO, Busan, Saturday.

kym@docdocdoc.co.kr

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