Highlights
- •Plasma lipid disorders are of increasing prevalence and concern in the Middle East.
- •Updated regional clinical recommendations consider recent international guidelines.
- •Middle East-specific cardiovascular risk categories were developed.
- •Recommendations support a more intensive treatment across risk categories.
- •Guidance considers screening, risk levels, treatment, and special populations.
Abstract
Background and aims
Disorders of plasma lipids remain key risk factors for the development of atherosclerotic
cardiovascular disease (ASCVD) in the Middle East and are estimated to increase more
dramatically in the next decade than in any other global region except Africa. This
statement is an update to the 2016 consensus clinical recommendations for the management
of plasma lipid disorders in the Middle East, following the evaluation of newer cholesterol-lowering
agents in randomised controlled cardiovascular outcome trials, as well as the publication
of revised international guidelines.
Methods
A multidisciplinary panel of regional experts was convened to update the consensus
clinical recommendations for the management of plasma lipids in the Middle East. The
recommendations constructed in 2016 were reviewed against emerging research since
publication.
Results
Newly developed Middle East ASCVD risk categories were established using the multiple
risk group categories from the recently updated international guidelines and the epidemiological
evidence from the Gulf Region. These consensus recommendations support a more intensive
reduction of LDL-C across cardiovascular risk categories. Alongside low-density lipoprotein
cholesterol, we recommend non-high-density lipoprotein cholesterol as a primary treatment
target. Lifestyle modifications remain the first-line treatment recommendation for
all patients. The first-line pharmacological treatment in patients with dyslipidaemia
is statin therapy, with a number of second-line agents available. The selection of
a second lipid-lowering agent for combination therapy with statin should be based
on the lipid-lowering target of the patient. Guidance is also provided on the management
of underlying conditions and special populations; of particular pertinence in the
region are familial hypercholesterolaemia, diabetes and metabolic dyslipidaemia. New
therapies have emerged from research that found positive outcomes in reducing low-density
lipoprotein cholesterol levels. The initial results of these newly researched drugs
strongly indicate their inclusion as future therapies in dyslipidaemia management
in the Middle East.
Conclusions
These updated consensus clinical recommendations provide practicing clinicians with
comprehensive, region-specific guidance to improve the detection and management of
plasma lipid disorders in patients in the Middle East.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: December 09, 2021
Accepted:
November 23,
2021
Received in revised form:
November 20,
2021
Received:
June 9,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
