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Cited by 43Lipoproteins and Cardiovascular HealthHealth Promotion and Cardiovascular PreventionCardiovascular Health and Risk Factors

World Heart Federation Cholesterol Roadmap

Open access
Murphy, Adrianna, Faria-Neto, Jose R., Al-Rasadi, Khalid, Blom, Dirk, Catapano, Alberico, Cuevas, Ada, Lopez-Jimenez, Francisco, Perel, Pablo +7 more·2017·Global Heart
DOI 10.1016/j.gheart.2017.03.002
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Abstract

BACKGROUND: The World Heart Federation has undertaken an initiative to develop a series of Roadmaps. OBJECTIVES: The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease. METHODS: Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these. RESULTS: Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders. CONCLUSIONS: Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap may apply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.

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  • apoB is a more accurate measure of the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C.

    “given that apoB is a more accurate measure of the adequacy of lipid-lowering therapy than LDL-C or non-HDL-C,1,3–13,27”

    From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [11]

    The supplied passages and searches for apoB, LDL-C, non-HDL-C, and lipid-lowering therapy return an unrelated 2026 journal article listing, with no section or page from the 2017 roadmap. Our available copy therefore provides no passage assessing whether apoB measures treatment adequacy more accurately than LDL-C or non-HDL-C. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • All reports since 2019, with one exception, including observational studies and randomized clinical trials, have confirmed that apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C.

    “Moreover, all reports since then, with one exception,2 including observational studies and randomized clinical trials,3–13 have confirmed that apoB is a more accurate marker of cardiovascular risk than LDL-C or non-HDL-C, reinforcing the validity of the evaluation by the 2019 EAS/ESC Guidelines as to the superiority of apoB.”

    From Discordance among apoB, non-high-density lipoprotein cholesterol, and triglycerides: implications for cardiovascular prevention (2024) · cites this paper as [11]

    The supplied passages contain a Global Heart article listing, not discussion from the Cholesterol Roadmap. Searches for apoB’s comparative accuracy against LDL-C and non-HDL-C returned the same listing; no passage in our copy addresses the claim about reports since 2019. (LLM, conf=0.72)

    Experimental — accuracy not yet measured

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Authors
Murphy, A., Faria-Neto, J. R., Al-Rasadi, K., Blom, D., Catapano, A., Cuevas, A., Lopez-Jimenez, F., Perel, P., Santos, R., Sniderman, A., Sy, R., Watts, G. F., Zhao, D., Yusuf, S., & Wood, D.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • University of Cape Town (ZA)
  • University of Milan (IT)
  • Clínica Las Condes (CL)
  • Universidade de São Paulo (BR)
  • McGill University Health Centre (CA)
  • Cardinal Santos Medical Center (PH)
  • The University of Western Australia (AU)
  • Capital Medical University (CN)
  • Population Health Research Institute (CA)
  • National Heart, Lung, and Blood Institute (US)
Corresponding author
Murphy, Adrianna
ORCID
Venue
Global Heart
Publisher
Ubiquity Press, Ltd.
Published
2017-09-01
Volume
12
Issue
3
Pages
179
ISSN
  • 2211-8160 (ISSN-L)
  • 2211-8179
DOI
10.1016/j.gheart.2017.03.002
OpenAlex
W2740003000
Cited by
43
References
17
Citations by year
2025: 3 · 2024: 7 · 2023: 6 · 2022: 9 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 2 · 2017: 1
FWCI
0.87
Type
journal article
Language
en
Open access
Licence
Locations
  • Global Heart (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
Funders
World Heart Federation
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
familial hypercholesterolemia, cardiovascular disease prevention, statin therapy, point-of-care testing, health system barriers, low- and middle-income countries, cardiovascular risk management, SMS reminders
MeSH terms
Cardiovascular Diseases, Cholesterol, Humans, Morbidity, Global Health, Practice Guidelines as Topic, Secondary Prevention

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