Executive Summary of

the 2020 Clinical

Practice Guidelines for
the Management of
Dyslipidemia in the
2020 Philippines
Dyslipidemia
CPG
 Introduction
The objective of the 2020 CPG on
Dyslipidemia is to provide
evidence-based recommendations
Methodology
Techinical Research
Committee

RCT meta-analyses,
Grades of Recommendation, Assessment,
Development and Evaluation (GRADE)- systematic reviews of
clinical outcomes were rated numerically on a studies, prospective
1-to-9 scale following the GRADE categories,
where a score of 7-9 is critical; 4 -6 important; cohort studies
and 1- 3, of limited importance
2020 Clinical Practice
Guidelines
Reporter: Dr. Josephine Sande Jaraba, DOH DTTB
Lifestyle Modifications Pinggang Pinoy
 For individuals at any level of
cardiovascular risk, cigarette
smoking cessation is
STRONGLY RECOMMENDED.
 For individuals at any level of
cardiovascular risk,
A LOW-FAT, LOW CHOLESTEROL
DIET, RICH IN FRUITS AND
VEGETABLES, E-CIGARETTE
SMOKING/VAPING CESSATION, &
ADEQUATE EXERCISE IS
RECOMMENDED.
Clinical Question Individuals with no prior
ASCVD Among non-diabetic individuals
without ASCVD but with multiple risk factors,
should statin therapy be given?

Yes!
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Primary Prevention
● For individuals without
diabetes aged ≥45 years
with LDL-C ≥130 mg/dL
AND ≥2 risk factors*,
without atherosclerotic
cardiovascular disease,
statins are
RECOMMENDED for
the prevention of
● cardiovascular events
Clinical Question Primary Prevention for
Individuals with Diabetes Mellitus• Among
individuals with diabetes without ASCVD,
should statins be recommended

Yes!
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For individuals Take Note! LDL goal of less than 100
with diabetes mg/dL for most persons with
without evidence of diabetes for primary
ASCVD, statins prevention.
are
RECOMMENDED For individuals with diabetes
for primary with >1 risk factor, LDL-C
prevention of goal of less than 70 mg/dL is
cardiovascular
recommended.
events
 An LDL-C of <55 mg/dL
For individuals Take Note! should be attained for
with diabetes secondary prevention in
without evidence of individuals with diabetes who
ASCVD, statins are at extremely high risk
are of having recurrent CV events
RECOMMENDED due the previous occurrence of
for primary major cardiovascular events
prevention of such as myocardial infarction,
cardiovascular
unstable angina or CVD
events
(stroke).
Clinical Question Dyslipidemia in the Pedia:
among pediatric population at risk for
premature cardiovascular disease, should
screening with fasting lipid profile be
recommended?

Yes!
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For pediatric population
(≤19 years old) at risk
for development of
atherosclerosis and
premature
cardiovascular disease,
screening with a fasting
lipid profile is
RECOMMENDED
Clinical Question Individuals with Chronic
Kidney Disease • For individuals with chronic
kidney disease who are not on dialysis, should
statins be given to reduce CV risk?

Yes!
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 Individuals with Among individuals with chronic
kidney disease who are not on
Chronic Kidney Disease dialysis, statins are
RECOMMENDED
for the prevention of cardiovascular
events
The recommendation in this local
guideline is to give statins for
Dyslipidem individuals with CKD not on dialysis.
ia is
c o m mo n b u
t not For individuals who are on renal
universal in
replacement therapy and post-
CKD.
transplant, this local guideline
recommends referring patients to
nephrologists for lipid management.
Clinical Question Individuals with Acute
Coronary Syndrome• Among individuals with
acute coronary syndrome (ACS), should statins
be given?

Yes!
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Secondary Prevention Pag e 4
Individuals with Acute
Coronary Syndrome
For individuals with ACS,
early high-intensity statin
that is maximally-tolerated
is RECOMMENDED and
should not be discontinued.
Statins should be given to
ACS patients immediately
Clinical Question Use of Ezetimibe Among
individuals with ASCVD, should ezetimibe be
given on top of statin therapy?

Yes!
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Secondary Prevention Pag e 5
Individuals with Acute
Coronary Syndrome For individuals with
documented ACS, and target
LDL-C has not been reached
despite maximally-
tolerated high-intensity statin
therapy, ezetimibe may be
added on top of statin
therapy to get to goal LDL-C
Clinical Question Use of Fibrates Among
individuals with ASCVD, should fibrates be
given on top of statin therapy once LDL-C goal is
achieved?

No
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 Individuals with Among individuals without diabetes
Atherosclerotic not at goal LDL-C, routinely adding
Cardiovascular Disease fibrates on top of statin therapy is
NOT RECOMMENDED for primary
Adding fibrates to statins
or secondary prevention of
may be considered among cardiovascular disease.
MEN with controlled
diabetes, low HDL-C (<35 Among individuals with diabetes,
routinely adding fibrates on top of
mg/dl) and persistently statin therapy is NOT
high triglycerides (>200 RECOMMENDED for primary or
mg/dl) for prevention of CV secondary prevention of
cardiovascular disease.
disease.
Clinical Question Use of Omega Fatty Acids Among
individuals with ASCVD, should omega fatty acids be
given on top of statin therapy once LDL-C goal is
achieved?

No
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 Individuals with
Atherosclerotic Among individuals with
Cardiovascular Disease
ASCVD on statin
therapy at goal LDL-C,
Among individuals with
but with persistently
ASCVD, omega fatty acids
(EPA+DHA) given on top of high triglyceride levels
statin therapy is NOT of 150-499 mg/dl,
RECOMMENDED. omega fatty acids (pure
EPA) MAY be given.
FOUR PATIENT
GROUPS
 STATIN ADVERSE
EVENTS
Treatment with statins is
associated with a low risk of
developing statin-associated
muscle symptoms (SAMS), but
the benefits of cardiovascular
risk reduction outweigh the risk
(Figure 2).
 STATIN ADVERSE
EVENTS
Treatment with statins is
associated with an increased
risk of new-onset diabetes
mellitus, but the benefits of
statin treatment for
cardiovascular risk reduction
outweigh the risk.
Treatment with statins is not
associated with the
development of dementia
and cognitive dysfunction.
Treatment with statins is not
associated with an increased
risk of intracerebral
hemorrhage.
Clinical Question Use of non-HDL-C Among
individuals on statin therapy who have
achieved their LDL-C goal, should non-high
density lipoprotein cholesterol (non-HDL-C) be
used as additional target to reduce CV events?

May be used
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 Individuals on Statin
Therapy
Among individuals on statin
therapy who have achieved
their LDL-C goal, an elevated
computed non-HDL-C may be
used as an additional
therapeutic target to further
reduce CV events.
Clinical Question Use of Apolipoprotein B-100 Among
individuals on statin therapy who have
achieved their LDL-C goal, should
apolipoprotein B-100 be used as additional target to
reduce CV events?

May be used
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Apolipoprotein B-100 (apo B-100)
(molecular weight 500 kDa) is necessary
for the assembly and secretion of VLDL.
It contains hydrophobic areas that serve as
strong lipid-binding domains. It has
domains that could serve as binding sites
for heparin-like molecules and form the
basis for some of the cell surface
interactions of the apo B
containing lipoproteins. It contains
an LDL receptor binding domain (amino
acids 3100–3400), which allows the
specific uptake of LDL by the LDL
receptor.
Test Result
Generally, normal levels of apoB100 are between 40
and 125 milligrams per deciliter (mg/dL).
High apoB100 levels can be associated with
certain health issues, including:
familial combined hyperlipidemia, diabetes,
hypothyroidism, kidney disease, the use of certain
drugs, such as diuretics, androgens, or beta-blockers
Low apoB100 levels may also be problematic.
They could indicate:
Hyperthyroidism, Reye’s syndrome, which is a rare
yet serious condition that causes sudden swelling in
the brain and liver, abetalipoproteinemia, which is a
condition that prevents the body from properly
absorbing dietary fats, cirrhosis, or malnutrition
The 2020 CPG is designed to
be a guide for clinicians in
managing dyslipidemia for
the Filipino patient. This,
however, should not replace
sound clinical judgment by
doctors and the ultimate
decision for treatment should
involve both clinician and the
patient.
Thank You!!!