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Clinical Chemistry 56: 502-504, 2010. First published February 25, 2010; 10.1373/clinchem.2009.139196
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(Clinical Chemistry. 2010;56:502-504.)
© 2010 American Association for Clinical Chemistry, Inc.

Perspectives

Northern Light: A Commentary on the 2009 Canadian Guidelines for the Diagnosis and Treatment of Dyslipidemia and Prevention of Cardiovascular Disease in Adults

Ernst J. Schaefer1,a

1 Lipid and Heart Disease Prevention Clinic and Lipid Metabolism Laboratory, Tufts University School of Medicine, and Human Nutrition Research Center on Aging at Tufts University, Boston, MA.

aAddress correspondence to the author at: Lipid Metabolism Laboratory, Tufts University, 711 Washington St., Boston, MA 02111. Fax +617-556-3103; e-mail ernst.schaefer@tufts.edu.

The first 300 words of the full text of this article appear below.

Coronary heart disease (CHD)1 remains a leading cause of death and disability in both Canada and the US. Major established independent risk factors for CHD include increased age, male sex, hypertension, smoking, diabetes, increased total cholesterol [>240 mg/dL (6.2 mmol/L)] associated with increased LDL cholesterol [>160 mg/dL (4.2 mmol/L)], and decreased HDL cholesterol [<40 mg/dL (1.0 mmol/L)] (1). Based on the long-term follow-up of participants in the Framingham Heart Study, point systems have been developed allowing for the calculation of the 10-year risk of CHD (2). Studies by Ridker et al. (3), as well as other investigators, have documented that family history of premature CHD and increased high-sensitivity C-reactive protein (hsCRP) are also independent CHD risk factors, and a modified point system known as the Reynolds Risk Score has been developed that includes these factors for calculating 10-year risk of CHD (3). The recently released third iteration of the Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease includes both of these CHD risk prediction systems in their guidelines, and in part incorporates family history of premature heart disease (age <60 years in a first-degree relative) and increased hsCRP (>2 mg/L) (4).

Alterations in plasma lipid and lipoproteins have long been known to affect CHD risk based on experience in various animal models fed atherogenic diets and clinical observations in patients with familial hypercholesterolemia. Epidemiologic studies such as the Seven Countries Study and the Framingham Heart Study have supported these observations. Human dietary intervention studies in the 1960s and 1970s, in which animal fat was replaced with vegetable oils, showed that CHD risk could be reduced with dietary change. The beneficial effects of niacin in the Coronary Drug Project reported in 1975 further supported the . . . [Full Text of this Article]