Description

Atherosclerotic Cardiovascular Diseases (ASCVD), which surround myocardial infarction, stroke and peripheral arterial disease, rank among the primary causes of early mortality, disability and rising healthcare expenditures globally. The increasing burden of ASCVD demands targeted strategies for cardiovascular risk and disease prevention in order to reduce the related mortality and morbidity while lessening the financial burden on healthcare systems around the world. In recent years, progress in understanding how lipoproteins containing cholesterol contribute to cardiovascular disease, alongside the development of innovative therapies, presents new possibilities to alleviate the burden of ASCVD. These advancements have improved the capacity to hinder the buildup of atherogenic lipoproteins in arterial walls, which is a significant element in the pathogenesis of ASCVD. Preventing the negative effects of cholesterol exposure constitutes a vital part of healthcare strategies designed to address ASCVD. The World Heart Federation (WHF) cholesterol roadmap represents an essential initiative in tackling these challenges. This roadmap provides a conceptual framework for crafting national policies and healthcare methodologies that can surmount the barriers to cholesterol management, which would consequently avert the onset of ASCVD.

The WHF Cholesterol Roadmap

A thorough review of available guidelines and research articles since 2017, in conjunction with discussions with a group of specialists in dyslipidemia management and healthcare systems research from Low and Middle-Income Countries (LMICs), has resulted in the recognition of multiple vital areas for action to counter ASCVD:

Key principles for effective ASCVD prevention: The roadmap highlights the significance of primordial prevention, which concentrates on preventing the emergence of risk factors from a young age. It supports the availability of economical cholesterol testing and universal cholesterol screening, particularly concerning inherited dyslipidemias. Early detection is vital for prompt intervention, averting the advancement of atherosclerosis.

Health system roadblocks in LMICs: Within low and middleincome nations, substantial health system obstacles exist that impede the management of elevated cholesterol levels. These challenges surround a lack of resources, restricted access to medications and insufficient healthcare infrastructure. Addressing these issues necessitates targeted tactics that respond to the specific requirements of LMICs.

Strategies to overcome gaps and limitations: To tackle the recognized gaps, the roadmap suggests various solutions, such as improving access to affordable Lipid-Lowering Therapies (LLT), enhanced risk stratification models and applying high-intensity statin regimens when suitable. It also emphasizes the importance of multidisciplinary healthcare teams and health literacy programs to elevate both public and healthcare provider awareness regarding ASCVD and its prevention.

The roadmap endorses the following essential strategies: Focus on preventing risk factors, like high cholesterol levels, from an early stage in life.

Universal cholesterol screening: The accessibility of cholesterol assessments for everyone, especially to detect inherited dyslipidemias.

Risk stratification: Advancing from the conventional 10-year ASCVD risk to a lifetime risk perspective, incorporating sufficient risk estimators that consider genetic and environmental influences.

Lipid-Lowering Therapies (LLT): Guaranteeing broader access to LLT, including statins as fundamental medications. The application of combination therapies, like statins alongside ezetimibe, can assist in achieving and sustaining significant decreases in Low-Density Lipoprotein Cholesterol (LDL-C) for individuals at high risk.

Health literacy: Continuous education for both health professionals and the general public to enhance understanding of ASCVD and its risk factors. Health literacy initiatives should emphasize the significance of cholesterol management and compliance with prescribed treatments.

Adherence to treatment: Improving patient compliance with therapies, which is vital for attaining sustained cardiovascular health.

Hypercholesterolemia

Hypercholesterolemia, marked by elevated cholesterol levels in the blood, constitutes a significant risk factor for ASCVD. Tackling this challenge is essential in alleviating the burden of cardiovascular diseases in Portugal.

Propose preventive strategies: Drawing from the findings of the evaluation, the roadmap will suggest preventive strategies to address hypercholesterolemia in Portugal. These tactics will concentrate on improving cholesterol testing, expanding access to lipid-lowering therapies and encouraging public health campaigns to elevate awareness regarding the importance of managing cholesterol levels.

Conclusion

The WHF Cholesterol Roadmap presents a detailed framework for addressing the increasing global burden of ASCVD through effective cholesterol management. By tackling critical deficiencies in prevention, knowledge and healthcare system barriers, this roadmap provides practical strategies for lowering ASCVD risk. For Portugal, the formulation of a national cholesterol roadmap represents a vital move toward better managing hypercholesterolemia and averting the long-standing repercussions of cardiovascular diseases. These initiatives are vital in diminishing the occurrence of ASCVD and improving public health results in Portugal and elsewhere.

References

1. Ludwig CF (1994) 1842--a landmark in nephrology: Carl ludwig's revolutionary concept of renal function. Kidney Int Suppl 46: 1-23.

   [Google scholar] [Indexed]

2. Sahay M, Narayen G, Anuradha (2007) Risk of live kidney donation-Indian perspective. J Assoc Physicians India 55: 267-270.

   [Google scholar] [Indexed]

3. Barai S, Gambhir S, Prasad N, Sharma RK, Ora M, et al. (2008) Levels of GFR and protein-induced hyperfiltration in kidney donors: A single-center experience in India. Am J Kidney Dis 51: 407-414.

   [Crossref] [Google scholar] [Indexed]

4. Barai S, Bandopadhayaya GP, Patel CD, Rathi M, Kumar R, et al. (2005) Do healthy potential kidney donors in India have an average glomerular filtration rate of 81.4 ml/min? Nephron Physiol 101: 21-26.

   [Crossref] [Google scholar] [Indexed]

5. Bakker J, Olree M, Kaatee R, de Lange EE, Moons KG, et al. (1999) Renal volume measurements: Accuracy and repeatability of us compared with that of MR imaging. Radiology 211: 623-628.

   [Crossref] [Google scholar] [Indexed]

6. Okoye IJ, Agwu KK, Idigo FU (2005) Normal sonographic renal length in adult southeast Nigerians. Afr J Med Med Sci 34: 129-131.

   [Google scholar] [Indexed]

7. Pruijm M, Ponte B, Ackermann D, Vuistiner P, Paccaud F, et al. (2013) Heritability, determinants and reference values of renal length: A family-based population study. Eur Radiol 23: 2899-2905.

   [Crossref] [Google scholar] [Indexed]

8. Ganesh R, Vasanthi T, Lalitha J, Rajkumar J, Muralinath S (2010) Correlation of renal length with somatic variables in Indian children. Indian J Pediatr 77: 326-328.

   [Crossref] [Google scholar] [Indexed]

9. Emamian SA, Nielsen MB, Pedersen JF (1993) Kidney dimensions at sonography: Correlation with age, sex and habitus in 655 adult volunteers. AJR Am J Roentgenol 160: 83-86.

   [Crossref] [Google scholar] [Indexed]

10. Han BK, Babcock DS (1985) Sonographic measurements and appearance of normal kidneys in children. AJR Am J Roentgenol 145: 611-616.

    [Crossref] [Google scholar] [Indexed]