Systematic review of clinical guidance for lipid management in adults with or at risk of atherosclerotic cardiovascular disease: A global perspective

Aims To identify clinical guidance globally on lipid management in adults who are at risk of or diagnosed with atherosclerotic cardiovascular disease (ASCVD) and to summarize recommendations for patients with increasingly prevalent diseases (diabetes, chronic kidney disease, and obesity), older adults, and women. Methods A systematic review of clinical guidance published within the last 10 years was performed by searching Embase, MEDLINE, and guideline-specific databases. Relevant guidance documents were selected by two independent reviewers. Recommendations pertaining to lipid testing, low-density lipoprotein cholesterol (LDL-C) goals, lifestyle modifications, and lipid-lowering treatment were extracted. Results A total of 109 clinical practice guidelines and expert consensus statements were identified, which were international (10%) or developed within Europe or the United Kingdom (31%), Asia-Pacific (26%), the United States or Canada (23%), Latin America (5%), the Middle East (5%), or Africa (<1%). Although clinical guidance provides common recommendations for lipid management in patients at risk of or diagnosed with ASCVD, including patients with diabetes or chronic kidney disease, recommendations concerning LDL-C goals and use of non-statin therapies often differ across guidance documents. Furthermore, recommendations specific to older adults, women, and patients with obesity are sparse. Conclusions Although clinical guidance from around the world provides a common framework for lipid management, important differences remain in recommendations concerning LDL-C goals, use of non-statin therapies, and management of certain patient populations. Future research and guidance development may help address these gaps and improve the consistency and applicability of recommendations across healthcare settings.