TEST DIRECTORY

Extract from Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022

Diagnostic criteria for dyslipidemia

* Basically, “Fasting” means abstinence from food for at least 10 hours. However, zero-calorie water or tea intake is permitted. If the patient is not confirmed to be in a fasting state, "any time" is defined.
**　 For patients classified as borderline LDL-hyper C, borderline non-HDL-C in the screening, examine their high-risk clinical conditions and consider the need for treatment.

• Use the Friedewald method (TC－HDL-C－TG/5) to obtain LDL-C levels. (However this is limited to fasting blood collection). Or use the direct methods.
• Use non-HDL-C (=TC－HDL-C) or LDL-C direct methods for patients with 400mg/dL of TG or higher, or blood collection at any time. When assessing the risk, however, remember that the difference from LDL-C may be smaller than +30mg/dL in patients without hypertriglyceridemia at the screening when using non- HDL-C.
• Reference value of TG is different between fasting blood collection and blood collection at any time.
• It is not subject to drug intervention in case of using only HDL-C.

Flow chart for setting LDL cholesterol target values from the perspective of coronary artery disease prevention using Suita score

Calculate based on score by Hisayama Study (Figure 3-2)
**50% or more of stenosis in internal, or external cranial arteries or arch aortic atheroma (maximal thickening ≥4 mm)
Note) Refer to Chapter 4 "Familial cholesterolemia", Chapter 5 "Primary dyslipidemia" instead of using this chart for patients with diagnosis of familial hypercholesterolemia and familial type Ⅲ hyperlipidemia, respectively.

Lipid target values by risk segment

* In diabetes, consider in the presence of PAD, microangiopathy (retinopathy, nephropathy, neuropathy) complications, or in the presence of smoking. (See Chapter 3, 5.2)
** To be considered when any of the four disease states "Acute coronary syndrome", "Familial cholesterolemia", " diabetes", or "coronary artery diseases or atherothrombotic brain infarction (including other brain infarction that clearly has atherom" are combined.

• In principle, use non-drug therapy to achieve the target values in the primary prevention. However, for any control segment with LDL-C levels ≥ 180mg/dL, consider drug therapy and also the possibility of familial hypercholesterolemia (refer to Chapter 4).
• First, achieve the target value of LDL-C and then aim to achieve the target value of non-HDL-C. Even if LDL-C target values are achieved, high non-HDL-C is often associated with hypertriglyceridemia, which is important to manage. Low HDL-C should basically be addressed with lifestyle improvement.
• These values represent a goal to strive for. Target values can also be LDL-C reduction rate of 20–30% in the primary prevention (low/medium risk).
• *** “Fasting” means abstinence from food for at least 10 hours. However, zero-calorie water or tea intake is permitted. The other conditions are defined as "any time".
• ****50% or more of stenosis in internal or external cranial arteries or arch aortic atheroma (maximal hickening ≥4 mm)
• Refer to Chapter 7 for elderly patients