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|Objective:||To analyse the prevalence of atherogenic dyslipidaemia in Latin America so as to make specific recommendations regarding the prevention, diagnosis and treatment of this dyslipidaemia in this region.|
|Design:||Systematic literature review with emphasis on publications related to Latin America using the Delphi methodology.1 Recommendations based on expert consensus were categorised as unanimous (100% acceptance), consensual (>80% agreement), or in disagreement (<80% agreement).|
Atherogenic dyslipidaemia was defined using the following criteria:
|Key questions addressed:||
|Conclusion:||This consensus group highlighted the need for a global study of cardiovascular risk factors in Latin America to define the true prevalence of atherogenic dyslipidaemia in the region, the impact of this dyslipidaemia on atherosclerotic cardiovascular disease, and, as a consequence, to derive appropriate management strategies.|
While risk factors for cardiovascular disease are the same for men and women globally, their presentation in different regions of the world varies. Latin America is distinct from other regions in that there is a higher prevalence of abdominal obesity, hypercholesterolaemia and hypertension.3 On average, over 60% of the population of Latin America has central obesity/overweight; hypertension, type 2 diabetes mellitus and dyslipidaemia are 2-3-fold more common in these individuals than those at normal weight.4 This risk factor profile has been exacerbated by demographic, economic and social changes in Latin America over recent years. With increasing urbanization, the typical diet has shifted to increased consumption of calorie-dense processed food with high fat and sugar content, and lifestyle has become more sedentary. About one in 4 adult in the region has a metabolic syndrome, although this can be as high as one in 2 in some countries.5-7 Together, these factors have driven the escalation in cardiovascular disease, predominantly ischaemic heart disease, with the result that this is now the major cause of disability, morbidity and mortality in this region.8
Atherogenic dyslipidaemia, the combination of elevated triglyceride-rich lipoproteins (and their remnants) and low HDL-C concentration, is recognized as an important contributor to lipid-related residual cardiovascular risk beyond LDL-C.9 Given the preponderance of obesity (especially central obesity) and type 2 diabetes in Latin America, atherogenic dyslipidaemia is likely to be an important factor underpinning the escalation of cardiovascular disease. Yet, as highlighted by this expert group, the prevalence of this dyslipidaemia in this region is not properly defined. Moreover, guidelines have focused on management of LDL-C as the major lipid target, without taking account of the distinct risk factor profile in this region.
This consensus statement makes an urgent call to action to address these unanswered questions. The group proposes a treatment algorithm for patients at high to moderate global cardiovascular risk with atherogenic dyslipidaemia, depending on fasting plasma triglycerides, using a cut-off of 200 mg/dl (2.3 mmol/l) for high triglycerides. This consensus statement is very much a step in the right direction. Action is now needed to address the unmet challenges in defining the profile of atherogenic dyslipidaemia in countries across this region, as well as developing region-specific guidelines for assessment and management of this important contributor to lipid-related residual cardiovascular risk.
1. De Villiers M, De Villiers P, Athol K. The Delphi technique in health sciences education research. Med Teach 2005;27:639–43.
2. Beltrán-Sánchez H, Harhay MO, Harhay MM, McElligott S. Prevalence and trends of metabolic syndrome in the adult U.S. population, 1999–2010. J Am Coll Cardiol 2013;62:697–703.
3. Hernandez-Hernandez R. Obesity: the most influencing and modifiable risk factors in Latin America. J Hypertens 2016 Sep;34 Suppl 1 - ISH 2016 Abstract Book:e6.
4. Lanas F, Avezum A, Bautista LE, INTERHEART Investigators in Latin America, et al. Risk factors for acute myocardial infarction in Latin America: the INTERHEART Latin American study. Circulation 2007;115:1067–74.
5. Márquez-Sandoval F, Macedo-Ojeda G et al. The prevalence of metabolic syndrome in Latin America: a systematic review. Public Health Nutr 2011;14:1702–13.
6. Miranda JJ, Herrera VM, Chirinos JA et al. Major cardiovascular risk factors in Latin America: a comparison with the United States. The Latin American Consortium of Studies in Obesity (LASO). PLoS ONE 2013;8:e54056.
7. de Carvalho Vidigal F, Bressan J, Babio N, Salas-Salvadó J. Prevalence of metabolic syndrome in Brazilian adults: a systematic review. BMC Public Health 2013;13:1198.
8. Lanas F, Serón P, Lanas A. Cardiovascular disease in Latin America: the growing epidemic. Prog Cardiovasc Dis 2014;57:262-7.
9. Fruchart JC, Davignon J, Hermans MP et al. Residual macrovascular risk in 2013: what have we learned? Cardiovasc Diabetol 2014;13:26.