Final Draft:
Best Practice Guidelines for Hypercholesterolemia
Edward E. Chung DM, FACP, FCCP, FACC
For the Caribbean Cardiac Society

Preamble

The basic principle underlying the issuance of guidelines or best practice statements is that the practitioner should be made aware of the importance of changes that have occurred within the medical literature and which impacts on the best practice of medicine so that he may be able to use these guidelines to improve patient care and management. Chronic Non Communicable Diseases have taken over from Infectious Diseases as the number one disease entity in the Caribbean region.  The ICSHIB study along with the Jamaican National Healthy Lifestyle Survey has identified Obesity, Hypertension, Hyperlipidaemia and Diabetes as significant problems within the region.  These studies also revealed that our females carry a disproportionately higher disease burden as they are more obese, have a higher prevalence of hypertension, diabetes and hyperlipidaemia and thus are at greater risk for the development of atherosclerotic vascular disease.

Introduction

The rationale for an aggressive approach to prevention of cardiovascular disease is due to the following observations:
-    Cardiovascular disease has been the leading cause of death within the Caribbean region. 
-    Atherosclerosis is identified as the underlying pathology in both coronary artery disease, stoke and peripheral vascular disease.
-    Sudden death occurs not infrequently from myocardial infarction and stroke.
-    Cardiovascular disease is related to identifiable physiological factors and lifestyle.
-    Risk factor eradication has been shown unequivocally to reduce cardiovascular morbidity and mortality.  For example: smoking cessation, cholesterol reduction and lifestyle modifications.

In December 2002 the Adult Treatment Panel III (ATP III) recommendations of the National Council on Cholesterol Education Panel (NCEP) was published.  This American guideline was followed by the Third Joint Task Force presentation of the European guidelines in September 2003.  Both set of guidelines are relatively similar apart from minor differences such as the use of different risk score methods.  Since that time seven major trials on lipid therapy have been published and this has prompted a call for the revision of these guidelines and leaves us to ask “How low should we go in reducing cholesterol levels?”   We will briefly review these studies later and provide our recommendations for therapy.