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2018 Guidelines for the Management of Dyslipidemia

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2018 Guidelines for the Management of Dyslipidemia GUIDELINE Korean J Intern Med 2019;34:723-771 https://doi.org/10.3904/kjim.2019.188 2018 Guidelines for the management of dyslipidemia Endorsed by Korea Society of Epidemiology, Korean Diabetes Association, Korean Endocrine Society, Korean Neurological Associa- tion, Korean Society for Biochemistry and Molecular Biology, Korean Society for Laboratory Medicine, Korean Society for The Study of Obesity, Korean Society of Obstetrics and Gynecology, Korean Society of Pediatric Endocrinology, The Korea Geriatrics Society, The Korean Academy of Family Medicine, The Korean Nutrition Society, The Korean Society for Preventive, The Korean Society of Heart Failure, The Korean Society of Hypertension, The Korean Society of Nephrology, The Korean Society of Sports Medicine Eun-Jung Rhee1, Hyeon Chang Kim2, Jae Hyeon Kim3, Eun Young Lee4, Byung Jin Kim5, Eun Mi Kim6, YoonJu Song7, Jeong Hyun Lim8, Hae Jin Kim9, Seonghoon Choi10, Min Kyong Moon11, Jin Oh Na12, Kwang-Yeol Park13, Mi Sun Oh14, Sang Youb Han15, Junghyun Noh16, Kyung Hee Yi17, Sang-Hak Lee18, Soon-Cheol Hong19, and In-Kyung Jeong20 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; 2Department of Preventive Medicine, Yonsei University College of Medicine, Seoul; 3Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; 4Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul; 5Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul; 6Department of Nutrition and Dietetics, Kangbuk Samsung Hospital, Seoul; 7Department of Food Science and Nutrition, The Catholic University of Korea, Bucheon; 8Department of Food Service and Nutrition Care, Seoul National University Hospital, Seoul; 9Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon; 10Division of Cardiology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul; 11Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul; 12Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul; 13Department of Neurology, Chung-Ang University College of Medicine, Seoul; 14Department of Neurology, Hallym University Sacred Heart Hospital, Anyang; Divisions of 15Nephrology and 16Endocrinology and Metabolism, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang; 17Department of Pediatrics, Wonkwang University Sanbon Medical Center, Gunpo; 18Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul; 19Department of Obstetrics and Gynecology, Korea University Medical Center, Seoul; 20Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea This article is being simultaneously published in Korean Journal of Internal Medicine and Journal of Lipid and Atherosclerosis by the Korean Association of Internal Medicine and the Korean Society of Lipid and Atherosclerosis. Correspondence to In-Kyung Jeong, M.D. Division of Endocrinology and Metabolism, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, Korea Received : June 9, 2019 Tel: +82-10-4283-9809, Fax: +82-2-440-7053, E-mail: [email protected] Accepted : June 19, 2019 https://orcid.org/0000-0001-7857-546X INTRODUCTION idemia, hypertension, diabetes mellitus, and smoking, are crucial [2]. The incidence of coronary artery disease Cardiovascular disease (CVD) is becoming more preva- (CAD) is rising in South Korea and although cerebral lent worldwide and is one of the leading causes of death hemorrhage has declined since 2002, cerebral infarction [1]. To lower CVD mortality, aggressive and comprehen- is on the rise [3]. This is speculated to be due to the ele- sive management of its risk factors, including dyslip- vated prevalence of dyslipidemia and diabetes mellitus Copyright © 2019 The Korean Association of Internal Medicine pISSN 1226-3303 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ eISSN 2005-6648 by-nc/4.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited4 http://www.kjim.org The Korean Journal of Internal Medicine Vol. 34, No. 4, July 2019 Table 1. Levels of evidence: classes of recommendation Definition Phrasing Level of evidence A Clear evidence for the recommendation Clearly proven through multicenter RCTs or meta-analysis with adequate content and power with high generalizability of findings B Reliable evidence for the recommendation Evidence found through well-performed cohort or patient-control group studies C Possible evidence for the recommendation Not reliable, but relevant evidence found through small RCTs, observational studies, or case series E Expert opinions No supporting evidence, but expert opinions based on clinical experience and expertise Classes of recommendation Class I Clear evidence (A) and benefits, and high applicability in practice Recommended Class IIa Reliable evidence (B) and benefits, and high or moderate applicability in practice Should be considered Class IIb Unreliable evidence (C or D) and benefits, but high or moderate applicability in May be considered practice Class III Unreliable evidence (C or D), may cause harm, and low applicability in practice Not recommended RCT, randomized controlled trial. with the growing obesity population, while hyperten- The fourth guideline consists of information about sion is well-managed and smoking rate has reached a the epidemiology of dyslipidemia, diagnosis and treat- plateau [4]. Thus, aggressive diagnosis and treatment of ment criteria, lifestyle interventions, drug therapy, and dyslipidemia, the most important risk factor for ath- dyslipidemia in specific patient groups. Finally, we pres- erosclerosis, are critical for lowering the incidence and ent currently available data and the need to develop and mortality of CAD and cerebral infarction. validate scales to assess the risk of CVD specific to Ko- To promote appropriate treatment of dyslipidemia, reans and CVD biomarkers appropriate for the Korean the Korean Society of Lipid and Atherosclerosis (KSo- population. The level of evidence and strength of rec- LA) published the first guidelines for the management ommendations used in the fourth guideline are shown of hyperlipidemia in 1996, the second guideline in 2003, in Table 1. The fourth guideline is available in full text the second revision in 2009, and the third guidelines for and an abstract form including tables and figures in Ko- treatment of dyslipidemia with added contents in 2015, rean. This paper is an English summary of the full text. in collaboration with 18 other relevant academic societ- We hope the fourth guidelines for the treatment of dys- ies and organizations [5]. However, new guidelines were lipidemia will be useful for health professionals treating published in Europe in 2016 and in the United States dyslipidemia. in 2017 based on new study findings, and new drugs, such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been launched [6-8]. Therefore, EPIDEMIOLOGY OF DYSLIPIDEMIA IN KOREANS the KSoLA Treatment Guideline Committee developed the fourth guidelines for treatment and management of Cardiovascular disease in Koreans dyslipidemia specific to Koreans based on evidence and CVD is the leading cause of deaths worldwide, with an expert opinions on the dynamically changing treatment estimated 17 million people dying from CVD every year modalities for dyslipidemia. [1,2]. In South Korea, the death rate resulting from dis- 724 www.kjim.org https://doi.org/10.3904/kjim.2019.188 Rhee EJ, et al. Korean dyslipidemia guidelines 500 400 300 Deaths 200per 100,000 Mortality rate (not age-adjusted) A 100 Figure tality rate (not age-adjusted). (B) Age-adjusted mortality rate (with reference to 2005 population). 0 1. 1983 Trends of cardio-cerebrovascular1984 mortality among Koreans, 1983 to 2016 (source: cause of death statistics). (A) Mor 1985 1986 50 1987 1988 1989 40 1990 1991 1992 30 1993 1994 Deaths per20 100,000 1995 1996 Mortality rate (not age-adjusted) 1997 A 10 1998 1999 Male Figure 2. 2000 Female tality rate (not age-adjusted). (B) Age-adjusted mortality rate (with reference to 2005 population). 2001 0 2002 2003 1983 2004 500 eases of the circulatory system was 187 men per 100,000 2005 Trends of coronary1984 artery disease mortality among Koreans, 1983 to 2016 (source: cause of death statistics). (A) Mor population and 145 women per 100,000 population1985 in 2006 1983 and 111 men per 100,000 population and 125 wom 1986 2007 400 2008 en per 100,000 in 2016, indicating little change over the 1987 Age-adjusted mortality rate (with reference to 2005 population) 1988 2009 300 years. However, the age-adjusted mortality rate, which 1989 2010 https://doi.org/10.3904/kjim.2019.188excludes the influence of aging of the population during 1990 2011 this period, decreased to about one-fifth of the initial 1991 2012
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