The leadership of the National
Lipid Association convened an Expert Panel to develop a consensus set of recommendations for patient-centered management of
dyslipidemia in clinical medicine. An Executive Summary of those recommendations was previously published. This document provides support for the recommendations outlined in the Executive Summary. The major conclusions include (1) an elevated level of
cholesterol carried by circulating
apolipoprotein B-containing
lipoproteins (non-
high-density lipoprotein cholesterol and
low-density lipoprotein cholesterol [
LDL-C], termed atherogenic
cholesterol) is a root cause of
atherosclerosis, the key underlying process contributing to most clinical atherosclerotic
cardiovascular disease (ASCVD) events; (2) reducing elevated levels of atherogenic
cholesterol will lower ASCVD risk in proportion to the extent that atherogenic
cholesterol is reduced. This benefit is presumed to result from atherogenic
cholesterol lowering through multiple modalities, including lifestyle and
drug therapies; (3) the intensity of risk-reduction
therapy should generally be adjusted to the patient's absolute risk for an ASCVD event; (4)
atherosclerosis is a process that often begins early in life and progresses for decades before resulting a clinical ASCVD event. Therefore, both intermediate-term and long-term or lifetime risk should be considered when assessing the potential benefits and hazards of risk-reduction
therapies; (5) for patients in whom
lipid-lowering
drug therapy is indicated,
statin treatment is the primary modality for reducing ASCVD risk; (6) nonlipid ASCVD risk factors should also be managed appropriately, particularly
high blood pressure, cigarette smoking, and
diabetes mellitus; and (7) the measurement and monitoring of atherogenic
cholesterol levels remain an important part of a comprehensive ASCVD prevention strategy.