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R E V I E W

5(3):151163

Hellenic Journal of Atherosclerosis 5(3):151163



-2014

Updated guidelines
of the Hellenic Society
of Atherosclerosis
for the diagnosis
and treatment
of dyslipidemia-2014

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. 5

M. Elisaf,1 Chr. Pitsavos,2


Ev. Liberopoulos,3 K. Tziomalos,4
V. Athyros5

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Professor of Medicine, Medical School,


University of Ioannina, Ioannina,
2
Professor of Cardiology, Medical School,
University of Athens, Athens,
3
Assistant Professor of Medicine, Medical School,
University of Ioannina, Ioannina,
4
Assistant Professor of Medicine, Medical School,
Aristotle University of Thessaloniki, Thessaloniki,
5
Associate Professor of Medicine, Medical School
Aristotle University of Thessaloniki, Thessaloniki, Greece

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.

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ABSTRACT: Dyslipidemia comprises a major risk


factor for cardiovascular disease, while its early diagnosis and effective treatment reduce cardiovascular
morbidity and mortality. The present article presents
the 2014 updated Hellenic guidelines for the diagnosis
and treatment of dyslipidemia in adults.

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Key words: Dyslipidemia, familial hypercholesterolemia, chylomicronemia, statins, fibrates, ezetimibe, cardiovascular disease.


.
, ,
, 451 10
: 2651 0 97509, Fax: 2651 0 97016
e-mail: egepi@cc.uoi.gr
2014

Prof. M. Elisaf
Department of Internal Medicine, University of Ioannina,
GR-451 10 Ioannina, Greece
Tel: (+30) 2651 0 97509, Fax: (+30) 2651 0 97016
e-mail: egepi@cc.uoi.gr

152

1.
(
,
) ( ).
( ) [ (LDL),
, (HDL),
(VLDL)]
.

2.
2.1.
:
1. ( ):
(>1000 mg/dL) ( )
2.
. (1/160.000-1/1.000.000 ):
LDL
. (1/200-500 ): LDL
3.
. (1/300 ): LDL , , HDL
. (
) (1:10.000 ):
LDL , , HDL
4. (1/2.000 ):

5. HDL : HDL

2.2
,
:
1.
2.
2014

3.
4. -
5.
6.
7.
.
.
.
.
. -
.
. -
.
. -
. -everolimus-tacrolimus.
.

3.


( , HDL
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4.
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10 .
SCORE
(Hellenic Heart
SCORE). Hellenic Heart SCORE (http://www.heartscore.
org/greece/Pages/Welcome.aspx http://www.hellenicscore.gr/) ( 1).
:
1. -

153

1. .
40 -

[ -

(eGFR) <60 mL/min/1,73 m2


]


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, ,
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(BMI) >27 kg/m2

SCORE
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3. ( <65
<55 ),
Heart SCORE
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4. [ , HDL , (a)]
(.. )

Hellenic Heart SCORE.
5. (<40 )
Hellenic Heart SCORE
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1. SCORE
10
.
2014

154

6.
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).

5.
( 2 3)
5.1.

[ ,
, (>50%)
2. .


( )

, , , ].
. 2
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. (eGFR<60 mL/
min/1,73 m2 / 3 )
. Hellenic Heart SCORE >10%.

( 4) LDL >50%
LDL <70 mg/
dL. .

5.2.
. Hellenic Heart SCORE 510%.
. (.. 3 ,
)
Hellenic Heart SCORE.
. .
. ( , , , ).

3. .




[ (>50%)
, ,
]
2 1>40
(eGFR <60 mL/min/1,73 m2 3 )
Hellenic Heart SCORE >10%

Hellenic Heart SCORE 510%



(.. 3 , ) Hellenic Heart SCORE


-
Hellenic Heart SCORE <5%
(.. 3 ,
)
2014

:
LDL

LDL
>50% <70 mg/dL.

.


LDL <100 mg/dL 3


LDL <115 mg/dL 3-6

LDL <100
mg/dL. 3 ( 4) , .

5.3. -
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(.. 3 , ).
LDL <115
mg/dL. 36 ( 4)
, .

6. Y

2.

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(


).
>500 mg/dL (
),
,
( 2).
4. .

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, )
/ ( LDL ~10%)
( 10% 6 )
( 30
60 min/ )

155


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, , HDL
LDL )
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( ),
(AST/ALT) - (CK).
(ALP)
( 6).
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,
CK ( )
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>3 (ULN)
CK>5 ULN .
CK,
.

( 6).
-- (GT)
.
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( 3),
. .

.

LDL 6%.
. LDL
( 3)
.
:
1. non-HDL =
HDL ,
2014

156

**


LDL CHOL



LDL CHOL

Y
HDL CHOL
TIT
***



LDL CHOL


DL CHOL

+
-3

LDL CHOL, TA T
DL CHOL

* >500 mg/dL / -3
**

*** 6% LDL CHOL
LDL CHOL=LDL , HDL CHOL=HDL , RG =
2. .

(>200 mg/dL).

,
. non-HDL 30 mg/dL LDL .
2. (<150 mg/dL)
HDL (>40 mg/dL >50 mg/dL ) .
. :
. ( 2014

,
)


.
.
1. .


.
, -

157

3. LDL .

5. .


1080 mg
2080 mg
14 mg
1040 mg
540 mg
540 mg
2080 mg

(10/10, 10/20 10/40 mg), (40/145 mg), (20/145 40/145 mg).


.
2. .
(>3 ULN)
.

.



.
3. .
>75 ,
.

6. .
: , , HDL , LDL , , , , , AST, ALT, CK, TSH,

48 : , ,
HDL , LDL , , , , ALT, CK ( )

612 : , , HDL
, LDL , ,
, ,
ALT, CK ( )

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, LDL , ,
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ALT, CK ( ), TSH

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LDL
.
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2014

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(3,8 g/ ).
LDL 30%. .
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mg
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.
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6. . , .

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(10, 20, 40 mg). -

(10 mg ) LDL ~20%


. ,
,
(>20%) LDL
( 1).
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(3,8 g/, 6
12 ) LDL ~20%
( ). H
( 1) ( +
).
(..
) , , ,
.
.
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: () (1 g/)
() 24 g/ ( 2). -3
30%
HDL ~3%.
-3 . -3


.
6.2.4. . HDL .

159

(>500 mg/dL),
-3 ,
.


( ).
(eGFR<60
mL/min/1,73 m2).
6.2.5. - ( ) ( 2). LDL ( , ,
, , )
,
.
[ ,
(apoB), LDL HDL ].
( LDL ) ( HDL )
.
-
. ACCORD
()
.

. , () 70%

.


31%
. , 2014

160

(

) ,

( ). ,

- .

. .

7.


LDL ,

apoB PCSK9 (proprotein convertase subtilisin/
kexin 9). 1:160.0001:1.000.000, 1:2001:500. .
40.000
.

LDL
( >500 mg/dL) . 2
.
LDL ( >190
mg/dL) 3
4 .
H
: () (
1 ) ()
LDL 95 . ,
, /
,

2014

. .
Dutch Lipid Clinic Network
,
( 9).
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<135 <100 mg/dL .
,
, <70 mg/dL.
LDL
( 4080 mg 40 mg
4 mg). , ,
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/
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(MTP) VLDL
, LDL
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26
LDL 50%.
, () .

LDL
( 5
8 ). , LDL .

161

9. Dutch Lipid Clinic Network .

Score
1 :
( <55 ;

<60 )

1
1
2

1 <18 LDL >95


LDL > 95

( )

( )

2
1


45

6
4

LDL , mg/dL (mmol/L)


330 (8,5)
250330 (6,58,4)
190250 (5,06,4)
159190 (4,04,9)

8
5
3
1

LDL , PCSK9

DNA
score
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67
35

LDL = ; PCSK9=proprotein convertase subtilisin/kexin9

.
apoB-100
LDL .
,
,
.

.


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. PCSK9
2014

162


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evolocumab alirocumab.
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, .
,

LDL .

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2014