Prof Ian Graham, Trinity College, Dublin, Ireland

Five new guidelines have been announced at the ESC2012, here Professor Ian Graham from Trinity College, Dublin, Ireland, talks about what’s new in the 2012 ESC Cardiovascular Prevention Guidelines.

Lipoproteins: changing the way we manage CVD risk
Professor Ian Graham from Trinity College, Dublin, Ireland was integral to the development of these new guidelines. During a symposium session at the ESC 2012 meeting in Munich, Germany, he outlined the main changes to these guidelines.

“We made these changes because we have to allow new knowledge to impact on what we say,” he says. So, for example the original score card has been adjusted to accommodate HDL, and these guidelines also introduce the concept of ‘risk age’.

“So, for example, if a patient is 40 years old but they have a very heavy risk burden they may have a risk age of 60,” he says.

“But the main change is that there are now four new categories of risk: Very High, High, Moderate and Low,” he says, adding that these categories are similar but not identical to changes adopted in the Joint Guidelines (JTF5). “The difficulty of ‘risk’ is that it’s a continuum,” he says. “We just had ‘high risk’ and ‘low risk’ before, and that meant a lot of moderate risk did not get adequately managed.”

High Density Lipoprotein (HDL) was not recommended as a target for CVD prevention. “There’s been a lot of interest in this during the conference, going beyond the guidelines” say Professor Graham. “The first point is that the trials that have been done with drug treatments have focused on LDL as a target and not at HDL, and that’s because we haven’t had very effective treatments for increasing HDL.”

“But that’s all going to change,” he continues. “The focus isn’t going to be on the level of HDL cholesterol, but more it’s functionality. There’s also dramatic new developments coming with new drugs over the next year or two. Whole different classes of drugs that will lower cholesterol even more, and will really push up HDL. So it’s going to be a very exciting couple of years.”